What Home-Based Care Leaders Should Know About The $1.66 Trillion Spending Bill

Home Heath Care News | By Patrick Filbin

The proposed $1.66 trillion omnibus government funding bill – which is expected to pass through the U.S. House and Senate this week – includes multiple home-based care provisions of importance.
 
Among those is new home health payment transparency language, an extension of the rural add-on, a separate extension of the Money Follows the Person program and more.
 
While home health and home care stakeholders will be pleased with some of what’s included in the omnibus spending bill, they will likely be at least partially disappointed that Congress did not postpone the 3.925% rate cut that was part of the home health final rule for 2023.
Providers had been pushing for that delay once the final rule was published. However, the payment rule will move forward as published.
 
One of the biggest wins for the home care industry is the absence of the 4% Medicare cuts across the board for 2023 and 2024, also known as the PAYGO reductions.
 
In March 2021, Congress passed the American Rescue Plan Act of 2021 (ARPA), a $1.9 trillion economic recovery package that included — among other things — a 10% increase to Federal Medicaid Assistance Percentage (FMAP) for home- and community-based services.
 
It also included $8.5 billion in Provider Relief Fund money for rural health care providers, including home health and hospice agencies.
 
That relief funding has to be paid via the Senate by law – Pay-As-You-Go, or PAYGO. Legislation can’t result in an increase to the federal budget deficit without an offset from increased revenue in one place or reduced spending in another.
 
In other words, the federal budget must be neutral.
 
Because of that, many in the home-based care world feared that providers would be called on to help offset ARPA’s spending. But that will not be the case.

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Government Funding Bill Extends Telehealth Flexibilities, Averts Cap Cut [Hospice]

NHPCO NewsBrief

On Tuesday, December 20, Congress released the text of the Consolidated Appropriations Act, 2023, an omnibus funding package that will fund the government through Fiscal Year 2023. The legislation contains measures that will affect hospices positively and negatively. We expect the legislation to pass and be signed into law later this week.

Key developments include:

• Telehealth extension: The legislation extends hospice telehealth flexibilities through the end of 2024, which were initially enacted as part of the CARES Act in 2020. This allows hospice patients and providers to continue to use telehealth for low touch, face-to-face visits prior to recertification for the hospice benefit. Patients will also be able to continue to participate in telehealth visits from home. 

• Continued slowdown of hospice caps: The legislation extends the cap calculation methodology implemented by the Improving Medicare Post-Acute Care Transformation (IMPACT) Act of 2014. For years that measure has slowed the growth of the hospice aggregate cap, reducing the total amount a hospice can be reimbursed for care provided to patients, as compared to the rates set prior to the IMPACT Act. The FY23 omnibus extends that IMPACT Act aggregate cap methodology by another year to 2032, meaning that for the next decade, many hospices will have to do more with less to continue providing patient care.

• Cap cut avoided: Beyond extension of the IMPACT Act methodology, there was some consideration to MedPAC’s recommendation to outright decrease the hospice aggregate cap by 20 percent. That cut was averted, protecting hospice patients and providers.

• Expanded definition of the IDT: The legislation will allow hospices, starting in 2024, to use marriage and family therapists (MFTs) and mental health counselors (MHCs) as part of the hospice interdisciplinary team.

• Focus on grief and bereavement: The bill designates $1,000,000 for assessing the feasibility of developing consensus-based quality standards for high-quality bereavement and grief care. It also directs the U.S. Department of Health and Human Services (HHS) Office of the Assistant Secretary for Planning and Evaluation (ASPE) to collaborate with other health officials to evaluate and report on the scope of need for high-quality bereavement and grief services, including a focus on the role of hospices in community services.

Read the press release or view our full member alert.

Congress’ Spending Bill Includes EARN Act Provision Supported by HCAOA

Democrat and Republican legislators released a massive $1.7 trillion 2023 omnibus spending bill early this morning, setting up a race to the finish line for the 117th Congress by the end of this week.

HCAOA  is proud to announce that the bill includes an HCAOA-supported provision (the Enhancing American Retirement Now - EARN Act) to make it easier for individuals and families to cover home care expenses and other home- and community-based services by allowing retirement account distributions for payment of long-term care insurance premiums. The provision eliminates the 10% penalty for early withdrawals when used for this purpose. A maximum of $2,500 can be distributed annually from a retirement account for this purpose. This amount will be updated annually for cost-of-living adjustments (Sec. 334 of the Act).

Inclusion of this provision follows months of intense advocacy from HCAOA and its members, who sent more than 1,000 messages to their legislators in support of home care.

“HCAOA is excited that leaders of both parties understand the importance of helping families get the home care they want and deserve,” said Eric Reinarman, HCAOA Vice President of Government Affairs. “This represents the latest step in what we hope is an ever-increasing commitment to both family caregivers and family-funded home care.”

HCAOA was also pleased that the agreement extends both the Money Follows the Person Rebalancing Demonstration program and the Medicaid Protections Against Spousal Impoverishment for Recipients of Home and Community Based Services through the 2027 fiscal year.

$1.7T Spending Bill Eases Medicare Rate Cuts, Extends Telehealth Waivers

Modern Healthcare | By Alex Kacik
 
Lawmakers unveiled a 4,155-page, $1.7 trillion spending bill Tuesday that includes provisions affecting the future of how healthcare is paid for and delivered across the nation, from the comfort of one's home to hospitals in rural communities.
 
The omnibus bill, which requires the approval of the House and Senate, has to be approved by the end of Friday or the government faces a potential shutdown.
Here's what's in the bill for healthcare.
 
Medicare rate cuts
The legislation outlines a 2% cut for Medicare rates to doctors in 2023, increasing the following year.
 
The proposed cuts are an improvement from the 4.5% rate suggested earlier this year. However, Dr. Jack Resneck Jr., president of the American Medical Association, said he is “deeply worried” that providers may stop taking Medicare patients, especially given additional strain from inflation, and again urged Congress to reform physician pay rates.
 
“The AMA is extremely disappointed and dismayed that Congress failed to prevent Medicare cuts next year, threatening the financial viability of physician practices and endangering access to care for Medicare beneficiaries,” Resneck said in a statement.

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