Archive for November, 2017

Tax Cut Bill Just Got Worse. Health Care at Risk.

Congress’ rushed effort to push through a massive tax cut for corporations and the wealthy presents a clear and present danger to health coverage, other vital programs, and families throughout the country. After adding $1.5 trillion to the federal debt, policymakers will use the higher debt – created by the tax cuts – to argue that deep cuts to Medicare, Medicaid, Social Security and other bedrock programs are necessary.

Amazingly, the tax cut bill just got even worse. After failing repeatedly to repeal the Affordable Care Act (ACA), the Senate is now seeking to repeal the ACA’s individual mandate to purchase insurance coverage in order to help pay for tax cuts. They know this will devastate the ACA.

According to the Congressional Budget Office (CBO), without this provision far fewer people – particularly younger and healthier people – will buy health insurance, which will lead to 13 million people without coverage, and higher premiums for millions more.

To add insult to injury, the CBO also stated that, in addition to the longer-term threats the tax cut poses to Medicare, the cut would also immediately threaten the program. Indeed, CBO projects that the enormous cost of the tax bill would prompt immediate, automatic and ongoing spending cuts to Medicare – $25 billion in 2018 alone.

It’s time to stop this fast-track process to starve the federal budget and pay for massive tax cuts by undercutting the health and economic security of millions of American families.

November 15, 2017 at 10:46 pm Leave a comment

Medicare Home Health Coverage is Not a Short-Term, Acute Care Benefit Congress Acted to in 1980 to Provide for Longer-Term Coverage

Medicare home health coverage is often erroneously described as a short-term, acute care benefit. This is not true. Although it may be implemented in this way, under the law people who meet the threshold qualifying criteria (legally homebound and needing skilled care), are eligible for Medicare home health coverage so long as they need skilled care.[1] In fact, Congress actually acted affirmatively to authorize long term Medicare home health coverage in 1980 – removing the annual cap on visits and rescinding the prior hospital stay requirement.

Congressional Action and Legislative History

The Omnibus Reconciliation Act of 1980 (OBRA 1980)[2], expanded the Medicare home health benefit. Prior to this, beneficiaries only enrolled in Part A were eligible for up to 100 home health visits annually, following a three day hospital stay. Coverage was also available under Part B, also limited to 100 visits per calendar year, but this coverage was not dependent on a prior hospitalization. OBRA 1980 eliminated the annual visit cap and the Part A prior hospitalization requirement, thus affirmatively expanding coverage for beneficiaries.

In the OBRA 1980 legislative history, Congress expressed a desire to further liberalize home care coverage, noting there were many “meritorious and deserving alternatives” proposed, and that agreement was reached on these particular improvements.[3] Thus, it is reasonable to infer that these changes – which made it clear that Medicare home care coverage is not short term or linked to acute care – were decisions Congress carefully considered and agreed upon.

Elimination of the Annual Cap on the Number of Covered Home Health Visits

Prior to 1980, coverage was capped under both Medicare Parts A and B at 100 home health visits per year. In the legislative history of OBRA 1980, Congress expressly stated that “unlimited visits would be available”[4] and that the “bill provides Medicare coverage for unlimited home health visits.”[5] The Congressional intent is clear: By removing the annual visit cap, Congress meant to authorize home health coverage for the long term – when appropriate and when other coverage criteria are met.

            Elimination of the Three-Day Prior Hospital Stay

Previously, beneficiaries only enrolled in Medicare Part A could not access home health coverage without a prior three-day hospital stay. This requirement did not apply to beneficiaries who also had Part B, as coverage under Part B was not predicated on a prior hospital stay. OBRA 1980 repealed the Part A prior hospital requirement. The Subcommittee on Health of the Committee on Ways and Means stated “Part A was designed to encourage early discharge of hospital and skilled nursing facility (SNF) patients who continue to need skilled care but not at the intensive level provided for in a hospital or SNF. The Part B benefit – no prior hospitalization required – offers those who require skilled care as an alternative to or postponement of hospitalization.”[6]

Congress eliminated the three day requirement under Part A, aligning it with Part B. (Thus allowing coverage under both Parts A and B “to postpone or avoid hospitalization.”) At the time, more than 1.1 million beneficiaries had Part A only and would benefit from the repeal of the prior hospital requirement.[7] Now, all beneficiaries can qualify for Medicare home health coverage whether they were recently hospitalized or not. Medicare home health coverage is available for homebound beneficiaries who need skilled nursing or therapy, whether they are recovering from an acute illness or injury and are expected to improve, or have a longer-term problem and need home care to maintain or slow decline of their condition. As Congress intended in 1980, Medicare-covered home care can often help beneficiaries forego avoidable hospitalizations.

Conclusion

Medicare can be a source of coverage for long-term home health care for people who qualify.

The relevant legislative history for OBRA 1980 makes it clear that Congress intended to “liberalize” the Medicare home health benefit, and that the changes were seen as “benefit increases” which would be “important to beneficiaries.”[8]

Congress’ 1980 action to reframe and expand Medicare home health coverage appears to be all but forgotten today. Home health care is often mistakenly referred to as a short-term, acute care benefit. This is in conflict with Congressional intent and long-standing Medicare law. The Center for Medicare Advocacy will continue to refute this fiction and advocate for beneficiaries who need and are eligible for long-term Medicare home health coverage and care.

November 7, 2017

[1] Medicare Benefit Policy Manual, Chapter 7 §§ 40.1.1 and 40.2.1.
[2] P.L. 96-499.
[3] Medicare Amendments of 1979, Report of the Committee on Ways and Means – 11/5/1979.
[4] Amendments to the Medicare Program, Subcommittee on Health of the Committee on Ways and Means – 6/15/1979.
[5] Conference Report, House Congressional Record, Pg 31375 – 12/1/1980.
[6] Amendments to the Medicare Program, Subcommittee on Health of the Committee on Ways and Means – 6/15/1979.
[7] Medicare Amendments of 1980, House Report of the Committee on Interstate and Foreign, Pg 47.
[8] Conference Report, House Congressional Record, Pg 24206 – 9/4/1980.

November 7, 2017 at 8:43 pm Leave a comment

New Medicare Payment Model Puts People Who Need Home Care in Jeopardy

BY 

Several decades ago, it was standard practice to keep patients in the hospital for days, or even weeks after the most routine procedures. For patients with chronic conditions the situation was even worse, often involving frequent, long stays in the hospital. Thanks to advances in home health care, older Americans now have the choice to age at home, while receiving quality health care.

Most home care for older adults is paid for through Medicare, which covered nearly 3.5 million people last year. This makes it all the more important that the Medicare home health benefit be strengthened – to promote quality, accessibility, and cost effectiveness. Regrettably, a new proposal does just the opposite.

Recent regulations issued by the Centers for Medicare & Medicaid Services, which propose a new home health payment system, are alarming. The proposed payment system, known as the Home Health Groupings Model, would radically disrupt the home health care landscape. HHGM and associated payments would discriminate against patients with chronic conditions, threaten access care in rural and undeserved areas, and cut hundreds of millions of dollars from the Medicare home health program.

Proposed to roll out as early as 2019, the HHGM is an untested model that would have significant, wide-ranging effects on access to home care for the most vulnerable older and disabled Medicare beneficiaries. Among its many provisions, HHGM would cut the standard episode of care from 30 to 60 days, which will favor beneficiaries who have the ability to recover quickly, while diminishing access for people who are clinically complex and have longer term, chronic illnesses and impairments.

The HHGM discriminates against those living with chronic conditions – who typically need care for longer periods of time – by assigning lower payment weights for cases with longer lengths of stay. Thus, those with the greatest need would be assigned the fewest resources, despite the fact that these are the very people who need the most intensive care. Further, beneficiaries who require care for longer than 30 days and have not been admitted to home care from a hospital or other institution will find it harder to obtain, and retain, home care. Payment under the proposed rule would be lower for this population.

Finally, it is unclear that the proposed payment rules are lawful as they conflict with Medicare coverage rules, which define the scope of the Medicare home health benefit. They also conflict with the settlement in Jimmo v. Sebelius, which reiterates that Medicare can cover long-term home care for people who need skilled care to maintain or slow deterioration of their conditions.

Fortunately, the administration still has an opportunity to change course before this harm occurs. CMS should pull the proposed payment rule and work with beneficiaries, advocates, providers and other stakeholders to develop a payment model that protects the integrity of the Medicare home health benefit – and ensures access to home care for all who qualify, including people with chronic conditions. The health and welfare of millions of older and disabled people are at stake.

November 2, 2017 at 3:11 pm Leave a comment


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