Home Health Services

Part of LeadingAge's 2021 Policy Priorities

LEADINGAGE ADVOCACY GOALS

  • Ensure that home health providers have access to testing, personal protective equipment, and vaccines to face the challenges of the Coronavirus pandemic.
  • Ensure appropriate reimbursement methodology and rates for home care and home health services across payers.
  • Advocate for reasonable home health and home care regulations to allow quality, community-based care without unnecessary burdens.
  • Work for meaningful inclusion of home care services in Medicare Advantage supplemental benefits with efficient processes and fair payment.
  • Promote a vision for the future of home health services and their role in the continuum of post-acute, long-term, and end-of-life care.

LeadingAge members are saying

  • “To succeed, we must have the ability to deliver the right care at the right time as we instill confidence in our at-home patients. Our patients need to know that we will navigate their disease process and circumstances.”
  • “We made a substantial financial commitment to developing a 90-day stockpile of PPE. In our home-based care services, we went from using 6 gowns a month to 300 in a week.”
  • “Our goal is to get better and get different to both control costs and increase the positive outcomes for the people we serve.

THE ISSUE

Home health agencies lived through a rollercoaster of activity during the pandemic year of 2020 with swings noted based on time and community cases of COVID. The combination of the introduction of the Patient-Driven Groupings Model payment system coupled with the loss of income and the increased expense of COVID have placed extraordinary financial strains on many home health agencies. While the regulatory flexibilities and relief funds that have come through the administration and Congress have been helpful more support is needed.

Like all health care providers, the pandemic has challenged home health agencies’ ability to provide care to patients. Specifically, since home health agencies deliver care in people’s homes, they faced a combination of fear and preference from both staff and patients and their families to receive fewer contacts and therefore, fewer in-person visits. Like others, home health providers have been able to overcome these challenges by utilizing telehealth to deliver some services to Medicare beneficiaries. However, a statutory provision prohibits visits made via telehealth from being considered equivalent to in-person visits. Therefore, unlike all other providers during the pandemic, the use of telehealth as an alternative to in-person visits often significantly reduced the level of reimbursement received by home health agencies. As a result, our home health members have been put in the untenable position of forfeiting adequate reimbursement to better protect their staff and patients.

Home health services are a vital component of the health care continuum both as an important discharge destination for hospitals as well as providing care and therapies that prevent hospitalizations. In 2018, 3.4 million Medicare beneficiaries received home health services with over 6 million episodes and nearly 617 thousand Medicaid beneficiaries received Medicaid-funded home health services.

Home health agencies must be recognized and reimbursed for their capabilities to coordinate and collaborate with other care providers, ensuring that the patient receives appropriate, high-quality care regardless of the setting or location in the evolving health care delivery system.

ADVOCACY ACTION 2021

117th Congress

  • COVID-19 relief: We support the House and Senate introduction of legislation that will provide funds and other relief for aging services.
  • Home Health Reimbursement: We continue to support legislative efforts that seek to ensure transparent and evidence-based approaches to Medicare reimbursement in the Patient-Driven Groupings Model
  • Reimbursement for Telehealth Visits: We support legislative efforts that allow virtual visits to be reimbursed by Medicare with appropriate guardrails and visit equivalency between in-person and virtual visits.

Executive Branch

  • Extend administrative flexibility: Support continuation of the Public Health Emergency 1135 Blanket Waivers that CMS put in place during the pandemic, including allowing occupational therapists, physical therapists, and speech-language pathologists to conduct initial assessments when therapy is part of the plan of care and the definition of the homebound requirement for home health services. We encourage HHS to add additional flexibilities, particularly around allowing documented verbal orders when obtaining physical signatures is an obstacle for beneficiary access to care.
  • Protect staff from COVID infection: Ensure that staff of home health providers, regardless of where the people they serve live, have access to a fully-funded national testing program, sufficient PPE, and Coronavirus vaccines when they become available.
  • Home Health Prospective Payment System: We will review and provide comments during the CY 2022 Medicare Home Health Prospective Payment System rulemaking process.
  • IMPACT Act: We will participate in the Medicare unified post-acute prospective payment system technical expert panel to provide the voice of LeadingAge members regarding possible future payment system design. This includes advocacy to slow the pace of model development work of the Department of Health and Human Services and the Center for Medicare and Medicaid Services to reflect relevant data collection not skewed by the experiences of the COVID-19 pandemic.
  • Advocate for the creation of claims codes or modifiers to document home health and hospice virtual visits: Hospice providers are utilizing telehealth for routine home care during the pandemic and home health providers are allowed to use virtual visits as part of their documented plan of care. We will advocate for the creation of claims codes or modifiers that will allow for the analysis of these encounters for a variety of purposes including quality measurement.
  • New Models of Integrated Care: Engage the Center for Medicare and Medicaid Innovation in the further development of a new demonstration or model(s) that would allow post-acute providers and/or LTSS providers to be accountable and financially at-risk for the care of a population or an episode of care.

ACTIONS YOU CAN TAKE NOW

  • Visit the Advocacy Action Center to let your representative and senators know you support the home health legislative priorities.
  • Host a Coffee Chat with Congress in your community to help your members of Congress understand how policies impact home health services.
  • Mobilize with the Advocacy Champions toolkit and let your representatives and senators know you support more opportunities to provide home health services.

ADDITIONAL RESOURCES