In The News

House Bill Could ‘Fast Track’ Medicare, Medicaid Cuts, Senator Warns

McKnight’s Home Care | By Adm Healy
A bill advancing through the House would create a process to expedite major fiscal policy changes, including cuts to the Medicare, Medicaid and the Social Security program, according to Sen. Ron Wyden (D-OR), Senate Finance Committee chair.
The Fiscal Commission Act would create a commission of experts tasked with identifying strategies for the United States to “improve the fiscal situation in the medium term and to achieve a sustainable debt-to-GDP ratio of the long term,” according to the bill’s text. The group, made up of both legislators and “outside experts,” would recommend ways that federal programs such as Medicare or Medicaid could improve their solvency over the next 75 years.
“The term ‘fiscal commission’ is the ultimate Washington buzzword, and it translates to trading away Americans’ earned benefits in a secretive, closed-door process,” Wyden said in a Jan. 18 statement.
Rep. Bill Huizenga (R-MI) and 13 others, a mix of Republicans and Democrats, introduced the bill last Sept. 28, and the number of cosponsors has since grown to 24. The House Budget Committee approved the bill on Thursday, moving it further towards official passage by the House. 
Wyden argued that the creation of such a fiscal commission would allow program cuts to be rushed through the legislative process. 
“The proposals … would fast-track cuts to Social Security and Medicare,” he warned in a statement, “and allow a handful of legislators and unelected political insiders to trade away Americans’ earned benefits in a secretive, closed-door process.”
He also requested that certain federal benefits, including Medicare and Medicaid, be barred from consideration by any fiscal commission. However, the House Budget Committee approved the legislation without such a provision.
“No one should be trying to claw back Americans’ earned Social Security and Medicare benefits,” he said. “I urge Speaker [Mike] Johnson to take Social Security, Medicare and Medicaid off the table as part of any proposed fiscal commission.”


Another ‘Doomy, Gloomy’ Home Health Landscape Awaits Providers In 2024

Home Health Care News | By Andrew Donlan
Home health providers could be facing a “doomy, gloomy” landscape in 2024, fresh off of two years that could be characterized as, well, doomy and gloomy. 
On Monday at the Home Care 100 conference in Scottsdale, Arizona, Partnership for Quality Home Healthcare CEO Joanne Cunningham tried to emphasize the positives, while also recognizing the realities. 
In particular, she harped on the need for the Preserving Access to Home Health Act to pass. The bill was introduced in the Senate in June, and in the House in August. A similar bill was also put forth in 2022, but failed to gain traction. 
“If things don’t change with regard to payment policy, we will see a very doomy, gloomy future of the PDGM payment stream,” Cunningham said. “I don’t think I’ve ever said it this emphatically, but we must see this legislation pass.”
The legislation would mitigate further cuts to fee-for-service home health payment cuts and any future payment “clawbacks” from the Centers for Medicare & Medicaid Services (CMS).
In addition, it would force the Medicare Payment Advisory Commission (MedPAC) – which regularly recommends additional cuts to home health payments – to view home health margins more holistically. 
“All of those [cuts] need to be wiped away,” Cunningham said. “This is also really important. In the legislation, we require MedPAC to do a better analysis of the financial condition of home health agencies right now. They take a very skewed look at the fiscal picture and financial stability picture of home health agencies.”
Part of the reason that view is skewed is because MedPAC does not include Medicare Advantage (MA) reimbursement for home health services, which tends to be considerably lower than fee-for-service reimbursement from CMS. 
On that note, MA remains one of the hot-button issues in the home health industry. 
Ironically, MedPAC also could finally be directing some of its scrutiny toward MA plans as well, Cunningham said. 
“The MedPAC staff recently presented a report that essentially said that, [according to their calculations], in 2024, CMS will be overpaying MA plans to the tune of $88 billion,” she said…

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Hospice Benefit Policy Manual Updates Related to the Addition of Marriage and Family Therapists or Mental Health Counselors to the Hospice Interdisciplinary Team

Palmetto GBA

Change Request 13437 (PDF) purpose is to manualize changes to the hospice interdisciplinary group (IDG) to include Marriage and Family Therapists (MFTs) or Mental Health Counselors (MHCs). In the CY 2024 Physician Fee Schedule Final Rule, CMS finalized modifications to the hospice conditions of participation to permit MFTs or MHCs to serve as members of the hospice IDG (§§ 418.56 and 418.114).

On November 29, 2023, CMS hosted a Hospice Open Door Forum call. On that call, several questions were asked regarding the new requirements for MFTs and MHCs that became effective January 1, 2024. Due to the number of questions, CMS developed and posted the below Questions and Answers Document. Please share this with your staff.


Support S. 2137/H.R. 5159 to Save the Medicare Home Health Program

Two weeks ago, NAHC & The Partnership held a Medicare Home Health Staff Briefing regarding the Preserving Access to Home Health Act of 2023 (S.2137/H.R. 5159). Here are the leave-behinds, including the testimonials, that were shared:

  • To download Mr. Dombi's presentation, CLICK HERE.
  • To download Ms. Edwards' presentation, CLICK HERE.
  • To download Ms. Massey's presentation, CLICK HERE.
  • To download the Home Care Chartbook 2023, CLICK HERE.

Passage of this legislation is imperative to ensure the continued functioning of the Medicare Home Health Program

Please click on the following link to send a message to your representatives, and then share it with staff, colleagues, family, friends and your social media outlets.


Patients, Families Overwhelmingly Prefer the Home as End-of-Life Setting, Researchers Find

McKnight’s Home Care | By Adam Healy
Patients and family members alike prefer the home over any other care setting for end-of-life care, researchers discovered in a review of more than 200 studies.
An analysis of all 229 studies found that as many as 89% of patients and 84% of family members prefer end-of-life care to be delivered in the home. The home is also the most preferred place of death, with more than half of patients indicating as such.
“There was consistency that home is the most favored place for EOLC [end-of-life-care] and death, both for patients and their families,” the researchers wrote in the review published by the Journal of Pain and Symptom Management.
Patients preferred to receive care in the home for a variety of reasons. Many reported feeling a sense of autonomy, dignity or peace at home, noting benefits such as being surrounded by family and friends. Caregivers, meanwhile, preferred patients experience end-of-life care in the home because many felt it respected the patient’s wishes and made their role as a caregiver more meaningful.
The Centers for Medicare & Medicaid Services has experimented with payment models that help keep end-of-life patients comfortably in their homes. A recent review of the Medicare Care Choices Model found that participants were able to spend up to five more days at home compared to those who were not involved with the program.
Still, a minority of patients and caregivers also indicated that they prefer other settings, such as hospitals, nursing homes or other facilities, for receiving care at the end of life. Some felt that clinical settings could provide better care, especially when the patient’s condition is especially acute. Home-based end-of-life care may also increase caregiver’s burden, or make it harder to connect with support when care is needed urgently.
And others may have no choice as to the setting in which they can receive care. Rural patients in particular might not have access to local providers, or resources to support home-based hospice or palliative care, which might affect some people’s decision-making.
“Some patients decide to sacrifice their preferences and move to another place, commonly to hospitals and hospice/palliative care facilities,” the researchers wrote. 
“However, these care facilities are not available everywhere, especially in remote or rural areas, and the lack of support at home is critical to the decision.”

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