Home Health & Hospice Week

But will demo patients be a financial liability for HHAs? If your state gets chosen to participate in the Medicare homebound demonstration project, it could open up a whole new market for your home health agency. And if the project succeeds, it could mean big changes for everyone.

The Medicare Modernization Act passed last December included a provision requiring a demonstration project to test a new, looser definition of "homebound" for Medicare home care eligibility purposes (see Eli's HCW, Vol. XII, No. 43). The demo aims to test whether using a less restrictive homebound definition will increase home health utilization and Medi-care costs, and/or boost patient outcomes.

The two-year project will take place starting Oct. 4 in three states, "representing northeast, midwestern, and western regions," the Centers for Medicare & Medicaid Services says in a May 7 transmittal.

Under the demonstration, Medicare beneficiaries with permanent, severe disabilities can qualify for home care services even if they leave the home frequently or for extended duration. (For eligibility requirements, see "Wrap Your Brain Around This New Homebound Definition"). Beneficiary participation will be capped at 15,000 patients.

CMS is staying mum on which states it will choose for the project, notes Mary St. Pierre with the National Association for Home Care & Hospice.

But all agencies in the chosen states will be able to participate in the homebound demo, notes Bob Wardwell with the Visiting Nurse Associations of America. The project won't be conducted "in an isolated few agencies," cheers Wardwell.

In that way, the demonstration is meant to mirror what the Medicare home care benefit really would be like if the changes to the homebound definition were made across the board, Wardwell tells Eli. Those disability advocates "who worked for this demo wanted it to run as much as possible like the law would have worked."

CMS has a full plate with all of its MMA duties, but it is prioritizing this demonstration by getting it off the ground nearly on time, Wardwell adds. The law requires a start date of June 9, but the project will begin Oct. 4.

The Demo Rundown

Here's how it will work: Once the demo begins, all HHAs in the three chosen states can enroll patients who fit the loosened homebound criteria. The process will include: Physician certification. The doc must "indicate in the open text remark section" of the plan of care "that he/she certifies that the patient has a severe and permanent condition and satisfies the requirements of the demonstration," CMS explains in the transmittal. Patient education. The HHA must inform the patient that she is eligible for home care under a special, limited-time demonstration project. The agency should encourage the beneficiary to take advantage of the more liberal homebound definition, CMS instructs.

The [...]