February 3, 2015

Home Health Cuts and Copayments in Administration’s Proposed Budget Threaten Access for Vulnerable Medicare Beneficiaries

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Leaders in the home health community raised concerns today in response to President Obama’s Fiscal Year 2016 budget that calls for the re-imposition of a copayment on Medicare home health beneficiaries. They warned that reinstituting beneficiary cost sharing policies on a Medicare population that is documented as Medicare’s oldest, poorest and sickest patient population has the potential to jeopardize seniors’ access to quality skilled home healthcare.

The Partnership for Quality Home Healthcare — a coalition of leading home health providers dedicated to developing innovative reforms to improve the program integrity, quality, and efficiency of home healthcare for our nation’s seniors — instead advocates for program integrity, value-based purchasing, and post-acute care bundling reforms that save Medicare dollars without burdening vulnerable seniors with high out-of-pocket costs and threatening their access to vital healthcare services.

Of great concern is the provision in the President’s 2016 budget proposal that calls for a copayment of $100 for new beneficiaries beginning in 2018. In response to this, the Partnership notes that Congress saw fit to repeal beneficiary cost sharing for home healthcare patients in the past because it failed to reduce healthcare costs and instead drove seniors to higher-cost institutional settings.

“Imposing further cuts on the already-strained home health delivery system or re-imposing a copayment on millions of the most vulnerable seniors is not the appropriate direction for Medicare or our nation,” stated Eric Berger, CEO of the Partnership for Quality Home Healthcare. “We regret that the President’s draft budget proposes to further reduce home healthcare funding and to re-impose repealed home health cost-sharing. However, we are pleased with other reforms outlined in the President’s budget and hope the Congress will adopt value- and integrity-focused reforms instead of more across-the-board cuts and the re-imposition of a patient copay.”

The President’s budget includes several provisions that align post-acute care (PAC) provider payments with quality and efficiency of care as well as the implementation of bundled payments for PAC services beginning in 2019. It also calls for increases in Health Care Fraud and Abuse Control (HCFAC) funding to more fully support program integrity and fraud prevention efforts at the Department of Health and Human Services.

To further advance similar reforms in the delivery of home healthcare, the Partnership strongly supports the following legislative measures:

• Securing Access Via Excellence (SAVE) Medicare Home Health Act: Halts the arbitrary, across-the-board rebasing cut of 14 percent that will be in effect through 2017 and replaces it with sustainable hospital readmission reforms that incentivize quality care for Medicare beneficiaries and achieve savings by reducing avoidable healthcare spending.
• Bundling and Coordinating Post-Acute Care (BACPAC) Act: Achieves significant savings by bundling payments for post-acute care and enabling patients to avoid rehospitalization and receive the treatment they need in the most clinically-appropriate and cost-effective setting.
• Skilled Home Health and Integrity Program Savings (SHHIPS) Proposal: Strengthens Medicare program integrity through solutions that will prevent the payment of aberrant claims before they occur and tighten the claims review process and conditions of participation standards for Medicare home health providers.

“We stand ready to work with the Administration and lawmakers to make program integrity, patient-centric bundling, and value-based purchasing reforms a reality,” added Berger. “By doing so we can help secure the Medicare program’s fiscal future while ensuring that our nation’s seniors are able to continue accessing the cost effective, clinically advanced and patient preferred home healthcare upon which 3.5 million homebound seniors depend.”

The Partnership is also a member of Fight Fraud First! — a coalition of groups representing millions of older Americans, persons with disabilities, minorities, veterans and healthcare providers urging lawmakers to eliminate waste, fraud and abuse in the Medicare program instead of imposing further cuts or a copayment.