This is Part Four of a ten-part CMA Issue Brief Series examining the growing crisis in access to Medicare home health coverage and necessary care – and outlining the Center for Medicare Advocacy’s work to address these issues. We invite you to follow this Issue Brief Series and submit Medicare home health stories to the Center at https://www.medicareadvocacy.org/submit-your-home-health-access-story/.
CMA Issue Brief Series: Medicare Home Health Care Crisis
- Overview – The Crisis in Medicare Home Health Coverage and Access to Care
- Medicare Home Health Coverage, Legally Defined
- Medicare Coverage for Home Care Is Based On a Need For Skilled Care – Improvement Is Not Required
- Misleading and Inaccurate CMS Medicare Home Health Publications
- The Home Care Crisis: An Elder Justice Issue
- Beneficiary Protections Are Lacking In Home Health Provider Conditions Of Participation
- Barriers to Home Care Created by CMS Payment, Quality Measurement, and Fraud Investigation Systems
- Proposed CMS Systems Will Worsen the Home Care Crisis
- A Further Examination of the Home Care Crisis: Published Articles and Statistical Trends
- Strategic Plans to Address and Resolve the Medicare Home Care Crisis
Misleading and Inaccurate CMS Medicare Home Health Publications
Summary: Medicare home health coverage law is clear. While the application of individual case facts to law is always open to interpretation, Medicare home health coverage law is not overly complicated. But the Centers for Medicare & Medicaid Services (CMS), the agency responsible for administering Medicare, continues to publish and communicate misleading and inaccurate statements about Medicare home health coverage. In turn, these actions by CMS perpetuate misinformation and confusion about home health coverage laws with the following:
- Medicare contractors who are responsible for payment of Medicare claims;
- Medicare certified home health agencies that deliver home health care services; and
- Beneficiaries who need accurate information about the benefits they may qualify for under law.
In Part 4 of our Medicare home health Issue Brief Series, CMA discusses the Medicare home health coverage laws, the definition of home health aide services, and statements made by CMS that miscommunicate coverage.
An outline of Part 4 is below. To read Part 4 in its entirety, go to https://www.medicareadvocacy.org/misleading-and-inaccurate-cms-medicare-home-health-publications
- Medicare Home Health Coverage Law
- Home Health Aide Coverage Defined (Includes, But is More Than Bathing!)
- 42 CFR §409.45(b) Defines Home Health Aide Services
- Medicare Benefit Policy Manual, Chapter 7, Section 40 Scope of Medicare Coverage for Home Health Aides.
- CMS Provides Incorrect and Misleading Coverage Myths: https://www.medicareadvocacy.org/misleading-and-inaccurate-cms-medicare-home-health-publications/#myths
- Social Security Program Operating Manual System
- 2017 CMS Medicare & Home Health Care Handbook
Conclusion: The Medicare Home Health coverage law is clear. Medicare beneficiaries have a right to know what benefits the law allows and how to qualify for those benefits. CMS should correct its misleading and inaccurate publicized statements to assist Medicare payment contractors, home health agencies, and beneficiaries understand the legally authorized Medicare home health coverage.
 42 U.S.C. 1861(m)