Home Health & Hospice Week

Home health agencies and patients could see a return to a more robust home health benefit under Medicare, if a new class action lawsuit succeeds.

Filed by the Center for Medicare Advocacy on behalf of plaintiffs with chronic disabilities, the suit “challenge[s] the [HHS] Secretary’s policies and practices that impede and restrict the availability, accessibility, and coverage of home health aide services for individuals with chronic, disabling conditions who qualify for such services under Medicare law,” according to the complaint. “While the eligibility criteria for home health aide services have remained virtually unchanged since Medicare was enacted in 1965, the services actually available to beneficiaries and covered by Medicare have dropped drastically over the past 20 years,” says the suit filed on Oct. 6 in Washington, D.C. federal court.

Among other items, the plaintiffs request that the court “ensure that class members who require and qualify for Medicare-covered home health aide services have reasonable access to the home health aide services authorized by the Medicare statute and regulations” and “administer and implement the home health benefit in a manner that does not discriminatorily deter access to reasonable and necessary Medicare-covered home health aide services for class members, and in a manner that comports with the mandate to provide aide services in the most integrated setting appropriate to the needs of class members,” according to the filing.

“Decades of misguided policy changes in the Medicare home health benefit have eroded rights guaranteed in Medicare law to over 60 million beneficiaries,” says National Association for Home Care & Hospice President William Dombi in a statement. “While the home health benefit includes 28-35 hours a week of medically necessary home health aide services, policy changes, arbitrary audit practices by Medicare contractors, and an endless series of payment rate cuts have made those rights a mere fiction,” Dombi maintains.

“In the past two decades alone, payment policies have effectively re-written the home health benefit,” Dombi continues. “The current 30-day episode base payment rate recognizes the cost of less than a single visit of a home health aide, rendering it impossible for any provider to offer 28-35 hours a week of aide services. You cannot realistically expect a home health agency to be able to deliver 28-35 hours a week of aide services with an effective $80 of reimbursement,” he blasts.

More to come: The Centers for Medicare & Medicaid Services “is now on a path to further dismantle the home health benefit with a proposed 7.69 percent rate cut that would take effect on Jan. 1,” Dombi cautions. “With the final rule expected this month, we hope that CMS recognizes the disaster in the making such a cut would trigger. We have asked the Administration to suspend that cut in hopes of getting CMS to re-evaluate its proposal.”

Note: The 56-page complaint is at https://medicareadvocacy.org/wp-content/uploads/2022/10/JOHNSON-COMPLAINT-FILED.pdf.