September 3, 2015

Home Health Leaders Commend Legislation to Streamline Medicare Patient Assessment Process

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WASHINGTON – The Partnership for Quality Home Healthcare – a coalition of home health providers dedicated to improving the integrity, quality, and efficiency of home healthcare for our nation’s seniors – today commended Senators Robert Menendez (D-N.J.) and Pat Roberts (R-Kan.) for introducing the Home Health Documentation and Program Improvement Act of 2015 (S. 1650), which will help to better ensure elderly homebound patients have access to clinically-necessary home healthcare services.

Under current Medicare policy, home health agencies can be unfairly denied payment for delivered healthcare services due to poorly designed and frequently misunderstood Medicare documentation requirements, commonly known as the face-to-face requirement. The Home Health Documentation and Program Improvement Act of 2015 strengthens the process used by the Centers for Medicare & Medicaid Services (CMS) to collect evidence regarding the eligibility of patients for home health services.

Specifically, the legislation will:

  • Eliminate the face-to-face encounter requirement for the approximately 60 percent of home health admissions that are preceded by a hospital, skilled nursing facility (SNF), or emergency room (ER) stay;
  • Ensure patients not seen by a physician in a hospital or facility do get a face-to-face visit proximal to home health admission;
  • Standardize documentation to collect evidence that a beneficiary is eligible for home health services; and
  • Create a path for reversing denials based on face-to-face narratives.

“We are proud to commend Senators Menendez and Roberts for being the first lawmakers in Congress to offer policy solutions for a regulatory burden that puts patient access at risk and unjustifiably takes physician and clinician attention away from the patient and onto paperwork,” said Eric Berger, CEO of the Partnership for Quality Home Healthcare. “This legislation would correct an onerous process that repeatedly results in claims denials and delays care for patients clinically in need of skilled home health services.”

Home health leaders warn the face-to-face requirement endangers access to care for the most vulnerable patient population in the Medicare program. Indeed, data compiled by Avalere Health reveal that Medicare’s home health beneficiaries are older, sicker, poorer and are more likely to be female, a minority, and disabled than all other beneficiaries in the Medicare program combined.

Nationwide, 3.5 million homebound Medicare beneficiaries depend on the home health benefit to receive clinically advanced, cost effective and patient preferred care.