In the News

SNF-at-Home Concept Earning ‘Very Positive Feedback’ in Congress, Among Special Interest Groups

Home Health Care News
By Robert Holly
 
An innovative care concept designed to keep patients at home and out of skilled nursing facilities (SNFs) is reportedly gaining ground in Congress and among special interest groups.
 
The concept — known as “Choose Home” — is a type of SNF-at-home model that leverages both medical and non-medical home care services for certain patients.
 
LHC Group Inc. (Nasdaq: LHCG) Chairman and CEO Keith Myers provided an update on Choose Home on Wednesday, after first floating the concept during a Feb. 26 earnings call.
 
“We have begun to socialize Choose Home legislation for the first time,” Myers said during a morning presentation at Oppenheimer’s annual health care conference. “This important legislation will provide a time-limited, cost-effective benefit, which would include Medicare-certified skilled home health services and personal care services for patients in the home.”
 
Myers revealed that the Choose Home concept would be for select patients who meet SNF requirements but who could safely recover at home with the right layers of medical and non-medical support. Telehealth and remote patient monitoring technologies would likewise play a role in the emerging model.
 
From a reimbursement perspective, Choose Home would create a new payment pathway around a 30-day episode of care. In theory, it could potentially lead to new Medicare access for non-medical home care agencies, which have historically operated mostly in the Medicaid and private-pay arenas…
 
“[We’re] receiving very positive feedback from Congress, as well as other interest groups such as AARP,” Myers said. “We anticipate that this legislation will be filed with Congress for consideration in 2021.”
 
In addition to individual companies like LHC Group, Choose Home is also supported by the National Association for Home Care & Hospice (NAHC) and the Partnership for Quality Home Healthcare (PQHH), according to Myers. 
 
“We are going to see favorable policies and regulations coming out of Washington, D.C., for home health, I believe,” he added. “We continue to work closely with the administration and Congress.”

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New Moving Health Home Coalition Aims to Expand Home-Based Care Services

A group of healthcare providers, valued-based care organizations, and Amazon’s telehealth business have come together to call for changes to reimbursement models that would support a range of services in the home from primary care to hospital-level interventions. A press release from the new organization, Moving Health Home, states that it is time to, “change reimbursement models and the culture around institutional care to allow for Americans to choose their home as a site of care.”

“We don't need to necessarily totally displace institutional care, but we need to make the home sort of an option for people for all different kinds of health care services,” stated the coalition’s manager, Krista Drobac. Founding members, which include Amazon Care, Landmark Health, Signify Health, Dispatch Health, Elara Caring, Intermountain Healthcare, Home Instead and Ascension, assert that, “care in the home can be at least equivalent to, if not better than, care offered in facilities.”

Moving Health Home’s policy priorities include retaining the hospital-without-walls site of care flexibilities that have been permitted during the COVID-19 public health emergency; eliminating institutional bias that favors institutional-based codes in the Medicare Physician Fee Schedule; creating an extended home-based care benefit as an alternative for skilled nursing facility care; and integrating telehealth.

Although the group sees home-based services as being different – or at least more encompassing- than home health, hospice, or non-medical homecare (personal care), their formation is further evidence of a very real shift that is taking place in the country; which should create plenty opportunity for providers already serving people at home.

 

Act Now to Extend Mortarium of Sequestration Cuts to Medicare!

On March 31, 2021 the suspension of the 2% Medicare sequestration will expire. That means rates of payments will go down 2% beginning April 1. Congress is actively considering legislation that will extend the sequestration suspension. Home health and hospice is an essential service during the ongoing pandemic, with more infected patients under care at home than other settings and patients with higher care needs shifting to home care for safe and effective care. Sequestration will reduce already stressed resources.

The House of Representatives is scheduled to debate H.R. 1868, legislation that would continue the sequestration suspension, on Tuesday, March 16. That bill would also avoid a 4% Medicare rate cut that is triggered by the recently passed Covid stimulus legislation.

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New Coalition Will Push For Expanded Home-Based Health Policies

Inside Health Policy/ By Maya Goldman
  
A new coalition of health care companies is advocating for increased Medicare coverage and reimbursement of at-home outpatient services, entering the health lobbying scene as the pandemic spurs interest in home-based care.
 
“We don't need to necessarily totally displace institutional care, but we need to make the home sort of an option for people for all different kinds of health care services,” said Krista Drobac, who manages the coalition.
 
The coalition will push policymakers to allow Medicare to cover an expanded list of services provided at a beneficiary’s home, which they’re currently compiling. The group also hopes to eliminate what it sees as an institutional bias in the Medicare Physician Fee Schedule. The 2021 fee schedule gave a bump to institutional-based E/M codes, while home-based services received a negative payment adjustment this year as a result of the fee schedule’s budget neutrality requirements.
 
Other policy priorities for the year include retaining site-of-care flexibility for home-based hospital services, advocating for home-based care for high-need patients and creating an extended home-based care benefit to serve as an alternative for skilled nursing facility care, similar to a benefit proposal being drafted by the home health associations.

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President Signs $1.9 Trillion COVID-19 Relief Package

On March 11, 2021, President Biden signed H.R. 1319, the American Rescue Plan Act of 2021 (ARP), a more than 600-page coronavirus relief package that provides $1.9 trillion in spending. The law was passed using budget reconciliation which required 51 votes for passage in the Senate. The legislation includes economic assistance programs related to the COVID-19 PHE and includes the following homecare and hospice related provisions:

1.   The ARP provides for a 10% one year increase in funding for the Federal Medical Assistance Program (FMAP), the federal share of Medicaid, beginning on April 1st. Funds are specifically designated for Home & Community Based Services and may be applied towards:

  • Home Health Care services
  • Personal care services
  • PACE services
  • HCBS Services
  • Case Management services
  • Rehab services

2.   A Rural Provider Relief Fund Allocation of $8.5 billion has been allocated for rural providers. The original draft of the legislation limited this provision to providers located in rural areas, but now includes providers that may be located in urban areas, but serve patients in rural areas.

3.   $12.2 billion has been provided to increase vaccination supplies and distribution capacity designed to speed up vaccine administration. These provisions will prove very helpful to home care and hospice providers and to their clients/patients in coming days.

4.   The ARP allocates $140 million to support healthcare providers’ mental health and emotional well-being.

While we are grateful to Congress and the President for the support of home care and hospice beneficiaries and those who provider their care, more action is needed, including further suspension of the Medicare sequester and passage of the long-anticipated HEAT Act that would provide for telehealth reimbursement in home health.

We also look forward to the momentum building behind the National Association for Home Care & Hospice’s call for “Choose Home” legislation that would create an enhanced home health benefit, serving as an alternative to the skilled nursing facility benefit.

It is anticipated that the House will vote on an extension of the Medicare sequester moratorium during the week of March 15th, prior to its scheduled expiration on March 31st. The National Hospice & Palliative Care Organization has prepared the following link to Ask your federal legislators to support the Medicare Sequester COVID Moratorium Act (H.R. 315).

 
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