Home Health & Hospice

CMS: Proposed budget includes home health co-pay

Homecare Insider, April 21, 2014

The White House administration has released its fiscal year (FY) 2015 proposed budget for the Department of Health and Human Services, which includes a $100 co-payment for each episode of home health care by Medicare beneficiaries.
An episode of care is defined as five or more visits over a period of 60 days or fewer that does not immediately precede a hospital stay. The legislation exempts LUPAs and episodes that are post-institutionalization.
The administration’s Medicare Payment Advisory Commission (MedPaC) hopes co-payments will alleviate Medicare spending and ensure the appropriate use of home healthcare. Home health is one of the few areas that currently includes no cost-sharing on the beneficiary’s part. While the co-pay is relatively inexpensive compared to the overall average cost of each home health episode ($3,000), critics worry that a co-pay would lead many home health beneficiaries who are used to free care to wind up in acute care or stay in long-term care longer, essentially costing Medicare more money than it pays now for the same individuals. The collection of the co-payment is also an administrative expense.
If passed, the co-payments would be effective in 2017.