Center for Medicare Advocacy

Advancing Access to Medicare and Healthcare

Proposed Home Health Rule Affirms Medicare Coverage and Payment for Patients Who Will Not Improve and May Need More Care than the Norm

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In the proposed rule, published in the Federal Register on July 12, 2018[1], CMS confirms that a patient’s condition does not need to improve for home health care to be covered by Medicare. CMS also acknowledges the following:

  • There have been reports of difficulty accessing coverable home health care, especially when the patient’s condition is not expected to improve; and
  • There is “confusion” among home health providers regarding possible payment for such care.

In the proposed rule, CMS addresses both patient coverage concerns and provider confusion over payment by describing a specific clinical example of how care for a patient could qualify for Medicare coverage and an additional outlier payment (in the example, the patient has ALS).

Further CMA analysis of the provisions of the proposed rule will be forthcoming.

July 12, 2018 – K. Holt