Thursday, October 10, 2013
Center for Medicare Advocacy Alert: Proposed Legislation Would Implement Home Health Episode Payment Caps
Caution: Home Health Episode Payment Caps Legislation was introduced on October 4th that could lead to a cap on the home health services available to a Medicare beneficiary. In the midst of a government shutdown, Representatives Matheson (D-Utah) and Guthrie (R-Kentucky) introduced the "Medicare Home Health Fraud Reduction Act" (H.R. 3245). This bill would establish maximum annual reimbursements to Medicare home health agencies. Instead of a payment cap for each beneficiary, such as the current annual cap on Medicare-covered outpatient therapy, this bill would impose an aggregate payment cap for each home health agency's caseload. While promoted as an anti-fraud measure that would have little impact on beneficiaries, to the contrary, the Matheson-Guthrie proposal is a dangerous policy that would create barriers to care for individuals with long-term, chronic conditions. Further, it would jeopardize implementation of the Jimmo v. Sebelius settlement. That settlement reiterates Medicare policy that medical improvement is not the deciding factor in determining the availability of Medicare-covered nursing and therapy services for persons with chronic conditions.
Over the past several years, legislators, think tanks, and other entities have offered policy proposals to reduce Medicare expenditures. Many of these proposals purport to save federal dollars by shifting additional costs directly to Medicare beneficiaries. Examples include: raising premiums for middle and higher income people; increasing deductibles and copays; prohibiting or discouraging the purchase of the most generous Medigap plans; and instituting copays (cost-sharing) for home health services. Many players potentially affected by proposals to reduce Medicare expenditures – including provider groups – act to thwart proposals that would adversely impact them. The home health industry opposes requiring copays on home health services, a position with which the Center for Medicare Advocacy strongly agrees. In an effort to ward off home health copays, elements of the home health industry have offered alternative proposals that could potentially save federal dollars by limiting the home health benefit for beneficiaries.