Advanced Search

Home Health & Hospice Week

Demonstration:

WILL HOMEBOUND DEMO MAKE YOUR LIFE HARDER?

Published on Thu Jul 15, 2004

Industry voices laundry list of concerns about the new project.

The upcoming homebound demonstration project could open up a whole new client base, but it comes with a lot of potential headaches as well, experts worry.

Chief on the list is whether the patients who qualify under the demo will bleed home health agencies dry. To qualify, patients in Colorado, Massachusetts and Missouri must meet a list of six criteria indicating they are in need of lots of medical and aide services.

These could be "heavy-duty patients," one caller remarked in the Centers for Medicare & Medicaid Services' June 25 special Open Door Forum on the project (see story, "Uncle Sam Wants You - For Homebound Demonstration").

Demo patients are likely to be "very different" from traditional home care patients, warned Mary St. Pierre with the National Association forHome Care & Hospice. In evaluating the project, CMS should carefully study how much it actually costs HHAs to serve these patients, since they are likely to need a higher level of care that wasn't figured into the prospective payment system rates, St. Pierre recommended in the forum.

Other concerns raised in the forum include:

  • HHQI. Outcomes data from these patients could skew agencies' overall home health quality improvement data, one caller noted. CMS reassured listeners that HHQI data, some of which appears on the Home Health Compare Web site, is risk-adjusted. But the caller worried that non-homebound patients would appear healthier on the OASIS assessment, avoiding significant risk adjustment, but would actually have worse outcomes.

  • Survey & certification. HHAs want some reassurances that surveyors won't ding them for taking on severely disabled patients that surveyors would rather see in institutions, commented Bob Wardwell with the Visiting Nurse Associations of America. CMS promised it will meet with state surveyors, accreditation surveyors and Medicaid departments to make sure everyone's on the same page.

  • Medicaid. Some disabled beneficiaries who are dually eligible for Medicare and Medicaid receive a high level of aide services from the Medicaid program, noted Janet Dauman with Colorado's Department of Health Care Policy and Financing. Dually eligible beneficiaries may not want to choose the Medicare home care benefit if it means their aide services will be cut, Dauman suggested.

    CMS hopes Medicaid programs won't withdraw coverage due to the demonstration, a CMS official said. Nothing precludes states from continuing to pay for non-Medicare-covered services, the official pointed out.

  • Patient needs. HHAs often won't be able to meet all of a severely disabled beneficiary's "relatively high" level of needs, Wardwell cautioned. Limited Medicare reimbursement and caregiver shortages mean agencies can't offer everything a patient needs, and agencies want reassurance that CMS will be supportive of that fact, said Wardwell, a former CMS official.

  • Homebound status. Beneficiaries may be reluctant to participate in the program because they fear being ruled not homebound after the demonstration program ends, one caller said. CMS promised patients wouldn't be penalized for participating in the demonstration, but the lack of details about the issue leaves room for worry.

  • Details. CMS furnished new details in the forum, but agencies still have lots of questions. For example, one caller asked for the definition of "technological assistance" for leaving the home -- one of the six criteria.

    CMS says it hasn't set a definition of that term yet, but that more details will be forthcoming as the implementation date approaches. The agency will issue a set of frequently asked questions on its Web site and will add to the FAQ as the demo progresses, a staffer said. And CMS will hold another special Open Door Forum on the topic near implementation time, she said.

    • Other Articles in this issue of

    Home Health & Hospice Week

    View All