It is always difficult to determine future policy because there are so many unknown factors that determine policy, such as oversee contingency operations, changes in the global economy, etc. However we can develop possible scenarios that may occur in the Trump Administration and 115th Congress based on some of the president-elects campaign promises, his choices of Cabinet secretaries and agency directors, as well as the possible new Congressional Committee chairs that may be influential in determining policy over the next year.
Rep. Tom Price is the president-elects choice for Secretary of Health and Human Services. In late September, Rep. Price introduced a bill to hit pause on the Home Health Pre-Claim Review (PCR) demonstration.
Prediction 1: We could see further delay or elimination of the pre-claim demonstration
Rep. Price is the House Budget Chairman, and in September he held a hearing delving into a potential repeal of the CMS Innovation that test new approaches to pay for care. Rep. Price has been among the sharpest critics in Congress of CMMI and its programs, especially the Comprehensive Joint Replacement program.
Prediction 2: We could see the elimination of some of the demonstrations, as well as more of a cautious approach in expanding existing and future demonstrations.
Rep. Price as the chairman of the Republican Study Committee, called for major decreases in federal spending. This policy, as well as the president-elect promises to rebuild infrastructure and increase defense spending could lead to major cuts in discretionary and mandatory spending. On the other hand, Rep. Price has been very supportive of maintaining funding for home health. He was a co-sponsor for the SAVE Medicare Home Health Act of 2014 that would have repealed the rebasing reduction adjustment for 2014 for home health.
Prediction 3: We could see more targeted budget cuts, and less costly regulatory changes to programs
House Speaker Paul Ryan's (R-Wis.) has close ties with Reince Priebus, the President-elects choice for Chief of staff. This relationship could facilitate Rep. Ryan's plans for changing Medicare, which could include introducing beneficiary cost-sharing requirements. Seema Verma, President-elect Trump's choice for CMS administrator has been a proponent of using co-payments in Medicaid to reduce costs and curtail inappropriate utilization.
Prediction 4: Possible co-pays for home health patients
Rep. Price and Rep. Ryan are proponents of a “premium support” system. Under a Medicare premium support system, older adults would get a set amount of money from the government to help them buy health insurance from a private insurance company, in contrast to the current government-run Medicare program. This change could lead to a major expansion of Medicare Advantage plans.
Prediction 5: We could see Medicare Advantage type plans and no traditional Medicare, which could impact the payment and operation of both home health and hospice.
Reps. Greg Walden of Oregon, John Shimkus of Illinois and Joe Barton of Texas are all vying to be the chair of the House Energy and Commerce Committee that oversees the Medicare and Medicaid program. Reps. Greg Walden had introduced the Home Health Planning Improvement Act that would allow nurse practitioners to order home health services.
The bottom line is that I don't have a crystal ball to predict future policy changes, but we should all be aware of the possibility of new opportunities and challenges for home health and hospice ride on our grassroots advocacy. The Congress and Administration need to hear from LeadingAge members and the elders they serve for us to help form a future where older adults receive quality home health and hospice services.