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 Volume 23.01

The Fiscal Year 2023 Appropriations Bill (“Omnibus Budget”) recently passed includes the following of immediate interest to home health providers:

Sequestration – The legislation extends Medicare sequestration into 2032 and sets the sequestration at two percent (2%) for 2030 and 2031.

Extension of Home Health Rural Add-On– The Omnibus Budget extended the add-on at 1%  for HHAs serving patients residing in “Low Population Density” areas in 2023.

Telehealth Flexibilities – The Omnibus Budget extends telehealth for practitioners in the patient’s home and permits home health face-to-face practitioner encounters through telehealth through December 31, 2024.

PDGM Rate Reduction – The legislation did not address the substantial 2023 rate reduction of 3.95%, which was previously reduced from 7.9%.  The rate reduction was only influenced by the Transparency Requirement included in the Omnibus Budget.

Transparency Requirement – The Omnibus Bill requires CMS to provide data used in developing the 2023 PDGM rule and associated payment rates.  CMS is required to hold some form of a stakeholder meeting and include advance notice of this meeting.


Citing substantial home health Medicare margins, MedPAC is expected to recommend to Congress a seven percent (7%) reduction to the home health base payment rate at its upcoming meeting.  Such a reduction in payment, coupled with inadequate payment rates from Medicare Advantage and Medicaid programs would substantially alter the financial ability of many agencies to provide services going forward.  There will obviously be an impact on access to care by all patients needing and qualifying for home health care services.


On December 29, 2022, the IRS released the 2023 optional standard mileage rates used to calculate the deductible costs of operating an automobile for business, charitable, medical, or moving purposes.

Beginning on January 1, 2023, the standard mileage rates for the use of a car (also vans, pickups or panel trucks) will be:

  • 65.5 cents per mile driven for business use, up 3 cents from the mid-year increase setting the rate for the second half of 2022.
  • 22 cents per mile driven for medical or moving purposes for qualified active-duty members of the Armed Forces, consistent with the increased mid-year rate set for the second half of 2022.
  • 14 cents per mile driven in service of charitable organizations; the rate is set by statute and remains unchanged from 2022.

Hospices can reimburse employees up-to 65.5 cents per-mile traveled with no tax impact to the employee.  It is important to note that under the Tax Cuts and Jobs Act, taxpayers cannot claim a miscellaneous itemized deduction for unreimbursed employee travel expenses.  Accordingly, employees cannot claim additional expenses above those reimbursed by the hospice.  Given continuing increases in costs associated with vehicles used to support hospice services, each hospice must determine its own policy regarding payments to employees for the use of their personal vehicle.


Prior to January 1, 2023, data on telecommunications technology used during a 30-day period of care at the patient level was not collected on home health claims.  Effective January 1, 2023, Home Health Agencies (HHAs) may begin voluntarily reporting the new telecommunications G-codes on HH claims with HH periods of care that start on or after January 1, 2023.  On July 1, 2023, reporting these new codes will become mandatory with HH periods of care that start on or after July 1, 2023.

Additional information is available at Telehealth Home Health Services: New G-Codes (cgsmedicare.com).