The Centers for Medicare and Medicaid Services (CMS) will slash funding and reduce services for vulnerable patients to access the Medicare home health benefit, despite substantive arguments from VNAA and other home health industry organizations, patient advocacy groups, providers and a bi-partisan group of over 193 members of Congress. Fifty-one senators and 142 representatives signed on to two letters to CMS raising serious concerns about the home health benefit and its proposed implementation of the rebasing provision.
In a Nov. 22 final rule, CMS cut funding for the Medicare home health benefit by $200 million starting Jan. 1, 2014. While CMS claims that reductions are only 1.05 percent in 2014, the actual base payment reduction for home health care services, or “rebasing,” is 3.5 percent annually for 2014- 2017. This is a cut that most definitely will curtail access to the benefit.
“VNAA will continue to fight for the right of vulnerable patients to receive the home healthcare they need. We are extremely disappointed that CMS would so dramatically reduce funding – especially because patients, physicians and hospitals want to increase use of the Medicare home health benefit to avoid institutional care for patients who can have their medical needs met at home,” said Tracey Moorhead, president and CEO of VNAA. “We will insist that access to home health care services, including skilled nursing, be closely monitored by CMS.”
Provision of medical care at home is viewed by many experts as critically important in reducing institutional costs for Medicare, Medicaid and private insurance. Although best practices and healthcare trends indicate that many homebound patients can receive effective care at home, only about 3.5 million of the 49 million Medicare beneficiaries are able to access the home health benefit.
CMS cuts in the Medicare home health mean that many homebound patients will lose the option of receiving skilled care at home and be admitted to high cost acute care, institutional settings, which is an outcome that is in direct conflict with the goal of reducing unnecessary care and costs. Cuts will impact elderly and disabled patients with multiple chronic conditions the hardest. VNAA’s mission-driven nonprofit agencies serve all who need care but are often the only agencies that take high-cost, low reimbursement patients who may be avoided by other providers.
A physician may order home health only if a Medicare beneficiary is homebound and requires skilled care. The benefit is mostly commonly provided in 60-day episodes but enables many vulnerable patients to avoid hospital or nursing home care.