THE ISSUES

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Choose Home Care Act: A Bipartisan Bill to Allow America’s Seniors
to Come Home Safely after Hospitalization

Home healthcare has long been a safe and effective alternative to care in an institutional setting. Medicare reforms are overdue to provide viable, extended care services at home for patients who otherwise have only one option: Medicare’s Skilled Nursing Facility benefit. The COVID-19 pandemic has vividly shown the limitations and risks of skilled nursing facilities (SNFs), and extended care at home beyond the pandemic makes sense. There is a better way to care for seriously ill Medicare beneficiaries after hospital discharge.

To address these limitations, home health leaders support a cost-effective and patient preferred home-based extended care program – Choose Home – to supplement the existing Medicare Home Health benefit that better supports patients who choose to recover at home following a hospitalization.

The Choose Home Care Act is designed to serve those who are clinically appropriate for healthcare in their own home but need more services than available under the existing Medicare Home Health benefit.

The Choose Home option would:

  • Allow nursing home eligible patients to have the option to receive health care at home following a hospitalization.
  • Allow patients to receive all care services provided under the Medicare Home Health benefit.
  • Allow patients to receive expanded home health benefit services AND transportation, meals, home modifications, remote patient monitoring, telehealth services, and personal care services for 30 days.
  • Not include cost sharing.
  • Combine payments for the home health amount and fixed add-on for expanded services.
  • Cap add-on payments for expanded services at 80% of the SNF 30-day payment amount, assuring significant Medicare savings under Choose Home.

Estimates suggest the Choose Home program could generate Medicare savings of $144-247 million per year (approximately 6.5-11.1% of SNF 1st PAC payments), with $1.6-2.8 billion in savings over 10 years, in SNF care substitutions. In simulations, Choose Home episodes tend to generate savings when substituting for SNF care as payment rates are not reflective of facility costs.

A recent public opinion poll, conducted by Morning Consult on behalf of the Partnership, underscores the popularity of home health and the importance of passing the Choose Home Care Act of 2021. Of the poll respondents, 86% of adults, including 94% of Medicare beneficiaries, expressed support for the Choose Home Care Act. The poll also demonstrated wide bipartisan support, with 83% of Republicans and 92% of Democrats showing support for the legislation.

Ensuring Appropriate Medicare Payments to Providers

On July 7, 2021, the Centers for Medicare & Medicaid Services (CMS) published its Proposed Rule to update the Home Health Prospective Payment System for CY 2022, in which CMS proposed to continue unsupported reductions to the rates and presented a flawed approach to assessing budget neutrality and suggested that home health payments were too high in CY 2020, an assertion the Partnership refutes and is contradicted by the data.

Concerned with the methodology used to establish payment rates in CY 2022 and assess budget neutrality, the Partnership worked with Dobson | DaVanzo to complete an analysis using Medicare claims data from 2020 as well as case-level impact and rate setting files from CY 2020, CY 2021 Final Rules and CY 2022 Proposed Rules. Key findings of the analysis include:

  • Medicare payments are already 5.76 percent lower than they should be based on the budget neutrality requirement, which runs counter to CMS’ methodology in the proposed rule.
  • Medicare’s behavioral assumptions under PDGM were inaccurate.
  • Medicare’s -4.36 percent behavioral adjustments alone could lead to a $2.43 billion reduction in home health over three years.

Further, a recent Labor Cost Survey of Partnership members concluded that CY 2020 and CY 2021 HHPPS payment adjustments are not reflective of labor and administrative price trends in the home health sector, but CMS is nonetheless proposing to use this data as a key component is setting 2022 rates.

The Partnership urges CMS to rescind the -4.36 percent behavioral adjustment for CY 2022 and accept our recommendations for a more accurate assessment of budget neutrality.

>STATEMENT: PQHH Recommends Rescinding Behavioral Assumption Cuts in 2022 Final Payment Rule

>ISSUE BRIEF: Analysis: CMS’ Approach to Establishing Budget Neutral Payment Rates is Flawed and Harms Both Providers and Patients

>ISSUE BRIEF: CMS: Final Home Health PPS Rule Must Recognize Increased Labor Costs

>ISSUE BRIEF: Key Policy Priorities for 2021

Supporting Care Delivery During the COVID-19 Public Health Emergency

As our nation continues to confront the COVID-19 outbreak, the home health community is working aggressively to protect patients, home health care providers, and the communities we serve. As the outbreak continues to develop, the Partnership is working with the Administration and Congress to identify actionable measures for expanding home health under current federal regulations and suggesting specific policy changes to address these issues:

  • COVID-19 Waivers and Flexibilities: The current waivers and flexibilities granted by Congress and CMS have helped both home health providers and their patients. The Partnership supports the continued extension of the public health emergency (PHE) and the use of these waivers and flexibilities during 2021 and for expanding and making permanent a number of the waivers.
  • Provider Relief Funds: The provider relief funds allocated under the CARES Act have helped home health agencies during the PHE. The Partnership supports use of these funds for home health providers for assistance with either expenses incurred or lost revenue.
  • Review Choice Demonstration (RCD) for Home Health Services: Due to the continuing public health emergency, the Partnership encourages CMS to delay implementation of these demonstrations until the PHE ends.

To learn more about the home health community’s response to COVID-19, CLICK HERE.