Today, the Bipartisan Policy Center (BPC) released a report titled “Optimizing the Medicare Home Health Benefit to Improve Outcomes and Reduce Disparities” available here. With support from the Commonwealth Fund, the Center for Medicare Advocacy (CMA) contributed an Issue Brief summarizing the legislative and regulatory history of the benefit, included in the BPC Report’s Appendix. The Commonwealth Fund also published a blog post by CMA titled “The Medicare Home Health Benefit: An Unkept Promise” discussing the Medicare home health benefit and referencing the BPC Report.
The BPC report is an important contribution to the current discourse surrounding access to the Medicare home health benefit. Among other things, the report highlights some of the factors inhibiting the provision of care to individuals with multiple comorbidities and complex conditions, including, as stated in the Executive Summary:
- “Inconsistent Medicare coverage determinations influence which beneficiaries home health agencies serve.
- Payment methodology and quality metrics disincentivize services for those with higher levels of need or without an expectation of functional improvement.
- Home health agencies overlook the importance of home health aides on recovery and health outcomes.
- Beneficiaries and family caregivers are not appropriately educated about home health services and do not receive adequate support.”
We concur with the Report’s request that “CMS should institute operational improvements to the administering of the home health benefit to ensure services are covered when eligibility criteria are met. In addition, payment policies should incentivize agencies to deliver an appropriate mix of services to qualified beneficiaries” (p. 7).
Further, the Report highlights how payment and other incentives and disincentives lead to the type of patients home health agencies take on:
Whether by selecting patients likely to require fewer visits or altering the type of services delivered, home health agencies tend to serve beneficiaries who will get better quickly and respond to the rehabilitative therapies that are likely to offer the most expedient improvement in functional status. However, the exclusion of aide services from care plans further disadvantages beneficiaries with chronic illness or cognitive deficits, particularly for those without a caregiver at home, and may exacerbate long-standing racial and ethnic health disparities within the home health care sector. [p. 13; citations omitted]
The BPC Report includes a disclaimer that it does “not examine whether Medicare Advantage enrollees face similar barriers to the home health benefit, and the recommendations in the report would address only the coverage, quality, and availability of Medicare home health services for beneficiaries in traditional Medicare” (p. 10), but does state that “[n]otably, Medicare Advantage beneficiaries receive fewer visits, have shorter episodes, and experience lower quality care” (p. 20).
CMA agrees with many of the recommendations in the BPC Report, but we must point out that we disagree with how home health coverage is framed as only a short-term benefit in the report. For example, it is described as “a narrowly defined benefit for individuals who need skilled care for short periods of time but are unable to leave the home to receive it” (Executive Summary, p. 5; also see p. 7 and Introduction at p. 9). In short, this is a misstatement of the law.
UPDATE: In June 2022, BPC updated the language in the report to address these concerns so that the report now more accurately characterizes the home health benefit. We appreciate BPC doing so.
CMA has a long history of pointing out misconceptions about, and problems accessing, the Medicare home health benefit, including the widespread misunderstanding that the benefit is only available for a short period of time. While this is how the benefit is often implemented, Medicare law and rules specify that coverage is not limited in time or visits. For example, coverage is available… “without regard to whether… it is expected to extend over a long period of time.” Medicare Benefit Policy Manual (MBPM), Ch. 7, Sec. 40.1.1; Coverage for skilled nursing is available so long as the beneficiary requires skilled care for services to be safe and effective, MBPM, Ch. 7, Sec. 40.1.1; and Payment can be made for an unlimited number of covered visits, 42 C.F.R. § 409.48(a)-(b); MBPM, Chapter 7, § 70.1.
With this important caveat, we hope that policymakers will review and act upon the recommendations in the BPC Report. For further information about problems accessing Medicare home health coverage, see, e.g., these Center for Medicare Advocacy resources:
- Home Health – Center for Medicare Advocacy (CMA website)
- New Resource | Home Health FAQs – Center for Medicare Advocacy (Feb 2022)
- CMA Home Health Survey | Medicare Beneficiaries Likely Misinformed and Underserved (medicareadvocacy.org) (Dec 2021)
- Issue Brief | Medicare Home Health Coverage: Reality Conflicts with the Law (April 7, 2021)
- Medicare and Family Caregivers (June 2020)
- Issue Brief: Medicare Payment vs. Coverage for Home Health & Skilled Nursing Facility Care (March 3, 2020)
- Plans to Address and Resolve the Medicare Home Care Crisis (October 18, 2018)
- Statistical Trends and Published Articles with Studies and Research from 2002-2017 (August 23, 2018)
- The Promise and Failure of Medicare Home Health Coverage (Dec 2016)
April 28, 2022 – D. Lipschutz