Medicare pays home health agencies pursuant to the Patient Driven Grouping Model (PDGM), which calculates payment based on a formula that considers admission source, diagnoses, and timing. Under PDGM, agencies are paid more for care provided to … [Read more...] about Medicare’s Home Health Payment Model Doesn’t Reflect the Care Many Patients Need
Home Health
Know Jimmo | Home Health Care is Available for Medicare Beneficiaries with Long Term, Chronic, and Terminal Conditions
The key to coverage is whether the individual requires skilled nursing or therapy and whether care would be safe and effective if skilled care was not provided. (And the individual meets other qualifying criteria: is homebound and has proper provider … [Read more...] about Know Jimmo | Home Health Care is Available for Medicare Beneficiaries with Long Term, Chronic, and Terminal Conditions
The Incredible Shrinking Medicare Home Health Coverage
The Medicare home health benefit should be an important lifeline for people in need of care to live safely and healthily at home. Under the law, people who meet Medicare qualifying criteria can receive covered home care on an on-going basis, with no … [Read more...] about The Incredible Shrinking Medicare Home Health Coverage
CMA Submits Comments on Proposed Home Health Payment Rules for 2026
The Center for Medicare Advocacy recently submitted comments on 90 FR 29108, Calendar Year 2026 Home Health Prospective Payment System (HH PPS) Rate Update Physician Fee Schedule Proposed Rule (7/2/2025). CMA's comments focused largely on the payment … [Read more...] about CMA Submits Comments on Proposed Home Health Payment Rules for 2026
Is Mobile Outpatient Therapy an Alternative to Home Health Care?
Home-based Medicare-covered physical therapy, occupational therapy and speech-language pathology services may be available outside of Medicare’s often inaccessible home health benefit. Mobile outpatient therapy is coverable under Part B, though it … [Read more...] about Is Mobile Outpatient Therapy an Alternative to Home Health Care?
When Should Medicare Cover Home Health Care?*
A 90-year-old woman needed home care after a hospital and SNF stay. Her family worked to set up the care with a knowledgeable, compassionate care coordinator. Nonetheless, the coordinator definitively informed the family that Medicare simply does not … [Read more...] about When Should Medicare Cover Home Health Care?*
Center for Medicare Advocacy Statement on Vice President Harris’ Proposal re: Medicare and Home Care
For Immediate ReleaseOctober 8, 2024Washington, DC - Today, Vice President Harris announced an historic proposal to expand Medicare coverage of care for critical services.The Center for Medicare Advocacy strongly supports this proposed … [Read more...] about Center for Medicare Advocacy Statement on Vice President Harris’ Proposal re: Medicare and Home Care
Medicare Home Health Coverage Was Expanded by Congress in 1980
Medicare home health coverage is often erroneously described as a short-term, acute care benefit. This is not true. Although it may be implemented in this way, under the law people who meet the threshold qualifying criteria (legally homebound and … [Read more...] about Medicare Home Health Coverage Was Expanded by Congress in 1980
Medicare’s Coverage of Home Health Aide Care: A Case Study
Mr. P, a 56-year-old Ohio resident, has quadriplegia resulting from an accident. He uses a wheelchair for mobility and relies on a Medicare-certified home health agency (HHA) for ongoing skilled nursing services. Mr. P also requires home health aide … [Read more...] about Medicare’s Coverage of Home Health Aide Care: A Case Study
CMS 2025 Home Health Care Notice of Proposed Rulemaking Released
The Centers for Medicare & Medicaid Services (CMS) released the 2025 Home Health Care Notice of Proposed Rulemaking last week. It was published in the Federal Register today at 2024-14254.pdf (govinfo.gov). The Center for Medicare Advocacy (the … [Read more...] about CMS 2025 Home Health Care Notice of Proposed Rulemaking Released