Home Health and Hospice Recommendations in MedPAC's March Report

MedPAC's March 2014 report to Congress includes several recommendations for home health care and hospice.

Home Health

The home health care recommendations include:

• Urging Congress to establish a program to incentivize home health agencies to reduce avoidable hospital readmissions from home health care. According to the report about 29 percent of post-hospital home health stays result in a readmission. MedPAC's intent is to align the incentives of home health agencies with those of hospitals under the Hospital Readmission Reduction Program and set the stage for home health agency participation in care-coordination models like Accountable Care Organizations (ACOs).
• Conducting medical review activities in counties that have "aberrant" home health utilization and implementing the new authorities to suspend payment and the enrollment of new providers if they indicate significant fraud;
• Commencing a two-year rebasing of home health rates in 2013 and eliminating the market basket update for 2012 (Med PAC believes the rebasing will be too modest);
• Revising the home health case-mix system to rely on patient characteristics to set payments for therapy and non-therapy services and eliminate the number of therapy visits as a payment factor; and
• Establishing a per episode copay for home health episodes that are not preceded by hospitalization or post-acute care use - $150 was suggested.

Also included in the report was mention of  common patient assessment items for use in home health agencies, skilled nursing facilities, inpatient rehabilitation facilities, and long term care hospitals by 2016. Please remember these are recommendations to Congress. Congress can adopt, reject or modify any of the recommendations.

Hospice

MedPAC's recommendations concerning hospice include:

• Elimination of the update to hospice payment rates for fiscal year 2015;
• Directing the HHS secretary to include the hospice benefit in Medicare Advantage plan benefit package;
• Revise the payment methodology to permit relatively higher payments per day at the beginning of the episode and relatively lower payments per day as the length of the episode increases, include a relatively higher payment for the costs associated with patient death at the end of the episode, and implement the payment system changes in 2015, with a brief transitional period.

Contact: Cheryl Udell, cudell@leadingageny.org, 518-867-8871