Bipartisan Policy Center Home Health Report

LeadingAge’s Home Health Member Network was joined by Lisa Harootunian, Associate Director for the Health Program and Tara Hartnett, Project Coordinator for the Health Project for a presentation on the Bipartisan Policy Center’s new report Improving Home Health Services for Medicare Beneficiaries. BPC staff shared a presentation on the findings of their report which included LeadingAge contributions. A full review of the report can be found here.

LeadingAge members asked questions about quality recommendations in the report specifically looking at incorporating social determinants of health which will be present in the new OASIS-E instrument. BPC staff shared that health disparities by race and ethnicity were identified in the report and that developing measures to reduce those disparities would be critical to close the health equity gap. The group also discussed the BPC recommendation around family education and training. BPC found that many families do not understand benefits available to them through the Medicare home health benefit and that many family caregivers do not feel prepared to support their loved ones. BPC therefore made a recommendation for ageinces to better educate families on what Medicare beneficiaries are entitled to and what care options are available through the home health benefit.

One critical recommendation from the support was increasing the use of home health aide services for home health beneficiaries. Members asked how this might be achieved given the workforce shortages faced in home health. The study authors shared that a lot of innovation is happening and that there are a handful of programs at the local and state level to bolster this specific workforce but nothing on a national scale at this time. BPC staff shared that all recommendations were focused on improving the Medicare fee-for-services home health benefit using existing CMS authority. BPC was invited to speak with CMS about their recommendations as well.

Home Health Member Introductions

Given the newness of the Home Health Member Network, the group took time during this meeting to introduce themselves, their organizations, the communities they serve, and interesting partnerships or programs at their agency. Below is a snapshot of LeadingAge Home Health Member Network participants:

• The median home health census was 100 patients with some smaller and larger outliers;
• Half of the agencies were associated with a life plan community or senior living campuses;
• Most agencies shared their staff retention rates were high but were facing upcoming nursing retirements and trouble recruiting new staff;
• Several shared concerns about insufficient Medicare Advantage contracting rates due to the saturation of agencies in their markets;
• Others shared struggles with burdensome Targeted Probe and Education audits looking at homebound status; and
• Interesting partnerships and programs included an in-house case management program, time limited private pay home care support for life plan residents, and an organization based managed long-term care plan.

Several agencies also shared they were gearing up for their survey process. The group shared what they had seen in their most recent survey which included:

• Medication reconciliation including a diaginosis for all medications patients were on;
• Infection control including hand washing and the “bag technique” for visits supplies;
• Emergency preparedness plans including write-ups for COVID yearly/two year emergency preparedness table meetings;
• Human resource vaccination status and exemptions tracking including how the agency kept patients safe with staff who were unvaccinated with an exemption and the agency kept up with changes to the state and CMS definition of “up-to-date” vaccination status;
• COVID policies/procedures/manuals and any education to staff including emails; and
• Cancelled visit policy and notification protocol to physicians’ offices.

Policy Update

Home Health Payment Manual Updates: CMS updated the home health billing manual to reflect changes to eliminate the Request for Anticipated Payment and add the Notice of Admissions process. In the original MLN article noting the changes and transition, concerns were raised regarding the definition of allowed practitioner, particularly paraphrasing regulations for advance practice nurse collaboration with physicians. CMS released an updated MLN and edits to the home health billing manual to clarify the definition of allowed practitioners.

Home Health Value Based Purchasing (HHVBP) Resources: The HHVBP technical assistance team released two expanded Model resources focused on quality measures and quality improvement. Both resources are designed to support agencies as they prepare for the first performance year, calendar year 2023. The on-demand video provides measure-specific information on each of the quality measures included in the expanded Model and the accompanying written resource provides a practical and visual guide to the quality improvement cycle as it relates to the expanded HHVBP Model and overall quality improvement efforts.

COVID Relief and Economic Package: On the legislative front, staff were waiting to see what Congress did around COVID relief. Congress was still having trouble coming to agreement on paying for any additional relief. There was also ongoing work on some sort of economic recovery package that included workforce and home and community-based services funding.

Action Campaign: To support ongoing COVID and economic relief efforts, staff urged members to take action on two action alerts: Ask Congress to Pass More COVID-19 Funding and Expand and Protect Funding for Older Americans

Appropriations: Appropriations season was in full swing, and more action will be needed with the bills move in the summer. While there were not any specific home health asks, substantive program changes can often be attached to these appropriations bill near the end of the process. LeadingAge will continue to monitor the process and report back to members.