Home Health & Hospice Week

Influential advisory body to Congress also focuses on home infusion.

You'll have to deal with copayments for home health services, if the Medicare Payment Ad-visory Commission gets its way.

Like a dog with a bone, MedPAC raises the idea of home health copayments once again in its new report to Congress, "Medicare and the Health Care Delivery System." The Commission urges lawmakers to undertake an overhaul of beneficiary cost-sharing to reform Medicare's benefit design.

In its budget-neutral proposal, MedPAC wants Congress to realign beneficiary incentives to reduce unnecessary utilization. One suggestion to do so is to establish copayments for different types of services.

Under the plan, Medicare would have discretion to set the copays. But MedPAC clearly expects home health to be subject to one -- in a benefit package example, the Commission offers the $150 per episode copay it's been proposing.

Other features of the proposal would include a limit on beneficiary out of pocket spending and a charge for supplemental insurance that covers most of a bene's current out of pocket costs. The latter would be aimed at bringing down unnecessary use of services.

MedPAC also recommends that the Depart-ment of Health and Human Services "alter or eliminate cost sharing based on the evidence of the value of services," however. That could be a good thing for home care services that keep beneficiaries out of the hospital or other high-cost settings.

"With HHS having exemption power, the value of home health and hospice could be advanced as proper sectors to exempt," notes the National Association for Home Care & Hospice.

The report also addresses:

• Home infusion. MedPAC couldn't gather enough data to determine whether expanding coverage of home infusion would save the Medicare program money, the report says. Targeting an expansion to certain drugs and instituting controls such as prior authorization might prove successful, the Commis-sion suggests.

• PACE. MedPAC wants changes to the Program for All Inclusive Care for the Elderly that would help PACE programs coordinate care for dual eligible patients. Those changes would include better risk adjustment and an outlier protection policy for patients with "exceptionally high acute care costs." The Commission also calls for lowering the PACE eligibility age for nursing home certifiable Medicare beneficiaries.

• Care coordination. Beneficiaries end up in higher-cost settings than required and receive redundant services due to care coordination problems. MedPAC focuses on physician service delivery, mostly the primary care physician, for care coordination issues in the Medicare program. v

Note: The report is online at www.medpac.gov/documents/Jun12_EntireReport.pdf.