The 2-year budget deal has many pros and cons for providers of long-term services and supports.

The Good News

  • SEC. 50202. REPEAL OF MEDICARE PAYMENT CAP FOR THERAPY SERVICES; LIMITATION TO ENSURE APPROPRIATE THERAPY. There is a projected $6.5 billion price tag associated with the therapy caps' elimination, so even though the repeal is good news, the offsets have a negative impact on home health, hospice, and nursing home providers.
  • SEC. 50208. EXTENSION OF HOME HEALTH RURAL ADD-ON. Even though the government is taking a more targeted approach to how they pay the add-on payments to rural home health agencies, LeadingAge is pleased the home health rural add-on will continue. There will be a range of 0.5 to 4% rural add-on payment based on the year, the number of episodes and population density. The legislation orders an OIG Report to evaluate the impact of the additional payments on access to home health services in rural areas.
  • SEC. 51006. RECOGNITION OF ATTENDING PHYSICIAN ASSISTANTS AS ATTENDING PHYSICIANS TO SERVE HOSPICE PATIENTS. LeadingAge has supported this legislation for the past two Congresses and is pleased that it was included. Physician Assistants play an important role in providing care for older adults, especially in rural areas. This provision will improve access to hospice.
  • IMPROVING ACCESS TO TELEHEALTH: LeadingAge has been actively lobbying on improving access to telehealth, although more needs to be done to increase the use of telehealth by home health providers
  • Sec. 50323. Increasing convenience for Medicare Advantage enrollees through telehealth.
  • Sec. 50324. Providing accountable care organizations the ability to expand the use of telehealth.
  • Sec. 50325. Expanding the use of telehealth for individuals with stroke. same as the House
  • NON DEFENSE CAP. The legislation increases the fiscal 2018 non-defense cap by $63 billion and the fiscal 2019 cap by $68 billion.
  • DEBT LIMIT. The agreement suspends the debt limit through March 1, 2019, which would allow the government to borrow to fully finance government operations. Under the measure, on March 2, 2018, a new statutory debt limit would automatically be re-established.
  • SEC. 51002. INFORMATION TO SATISFY DOCUMENTATION OF MEDICARE ELIGIBILITY FOR HOME HEALTH SERVICES. Eliminated the mandate that CMS uses that requires when determining coverage eligibility for home health to both physician and HHA records . CMS could still change its policy position on documentation. This change is a step in the right direction in easing the burden of the Home Health face to face requirements.
  • Sec. 52001 Independent Advisory Payment Board (IPAB) is repealed.
  • Sec. 53116 Part D Donut hole would be closed, but in Sec. 53114, higher income Medicare beneficiaries would pay more.

The Bad News

  • Home Health. Section 53110. Medicare payment update for home health services. Medicare reimbursement for home health agency (HHA) providers will increase by 1.5 percent in 2020. The spending bill updated the market basket rate for home health care to 1.5% in 2020. That’s a change from the 1.4% rate originally scheduled for 2019. The adjustment will result in a cut to overall home health care payments, approximately $3.5 billion over 10 years, according to the CBO. Actually, the 1.5% increase that will occur in 2020 is better than previous years. This change is not written in stone. MedPAC in the past has recommended no update for home health, and Congress and CMS have the authority to make changes that will reduce payments. Good news, a budget neutral move from 60 to 30 day episodes in the Home Health Groupings model is in the spending bill, which reduces the possibility of a large reduction in payment due to the change to the new payment system.
  • SEC. 51001. HOME HEALTH PAYMENT REFORM. (a) BUDGET NEUTRAL TRANSITION TO A 30-DAY UNIT OF PAYMENT FOR HOME HEALTH SERVICES- beginning with 2020 and ending with 2026. We are pleased that the payment is budget neutral because it was a major cut in the proposed rule. We are concerned that CMS is moving forward with changes to the Home Health payment system without testing the various components including the impact of moving away from the well established practice of having a 60 day episode. 
  • SEC. 53109. HOSPITAL TRANSFER POLICY FOR EARLY DISCHARGES TO HOSPICE CARE. This section adds hospice, as a setting of care, to the existing post-acute care transfer policy. Under the policy, hospitals would be paid less when the hospital transfers a patient to hospice, if that patient had a short length of stay in the hospital. The policy only applies in those cases where the patient falls into one of the top ten reimbursed hospital stays. The policy would begin on October 1, 2023.