Home Health & Hospice

MedPAC's Latest Recommendations

Homecare Insider, January 24, 2011

On January 13, 2011, the Medicare Payment Advisory Commission (MedPAC) voted to recommend that Congress impose several changes to the home health Medicare benefit. Those recommendations include the following:

  • Medicare should conduct medical reviews in counties where aberrant utilization is prevalent.
  • Congress should freeze home health payment rates in 2012 and amend the healthcare reform law to accelerate payment rebasing.
  • Case mix adjustment model should be revised to no longer use levels of therapy utilization to determine payment amounts.
  • A copay should be required for Medicare home health episodes that are not preceded by an inpatient hospital or skilled nursing facility stay. Low-utilization payment adjustment episodes would also be excluded.
  • A reprisal of a 2010 recommendation, which stated that steps be taken to prevent providers from stinting care in response to payment rate changes.

Of great and immediate concern to providers is the recommendation of a copay for Medicare home health episodes. This recommendation could require Medicare beneficiaries to pay a 150 dollar copayment for each episode of home health care. This dollar amount was offered merely as an illustration as no specific details were offered as part of the recommendation. The copay would also apply to dually eligible beneficiaries, which could leave states that are already financially strapped with the financial obligation.

In response to MedPAC’s recommendations, the National Association of Home Care and Hospice is promising development of a comprehensive advocacy plan and vows to uphold the interest of homecare providers.