The announcement on July 2, 2018, that CMS seeks to “modernize” Medicare home health care is filled with patient-oriented rhetoric, but will actually further gut the Medicare home health benefit – which is already being implemented in a way that doesn't work for many patients who are most in need.
New payment policies, such as those in the proposed rule, will continue to make it impossible to effectively implement Medicare coverage laws for millions of beneficiaries who qualify for care under the law. Medicare beneficiaries who meet home health coverage criteria will be forced to go without necessary care or enter institutions because home health agencies consider Medicare payments inadequate to cover their care.
Under the current payment system, for example, Medicare home health aide visits to provide patients with covered personal care services have declined from 48% to less than 10% over the past two decades despite no change in home health aide coverage laws. Changes in payment policies have driven the decline. The new proposed rule will further erode the lawful Medicare benefit and decrease delivery of home health aide services.
In the coming weeks, the Center for Medicare Advocacy will comment on these proposed rules. We urge others to participate by sharing or signing on to these comments. The crisis in access to home care is growing. This proposed rule would only exacerbate that trend and must be stopped. CMS must instead create a payment system that allows equal access to legal Medicare coverage, not a payment system that further illegally limits access to care and destroys lives.
July 5, 2018 – K. Holt
 http://www.medpac.gov/docs/default-source/reports/mar18_medpac_entirereport_sec.pdf?sfvrsn=0, see page 246 of MedPAC report, page 276 of pdf.