Home Health & Hospice Week

Rural providers will get a boost, but suspension of sequestration cuts ends this month.

The home care and hospice industries didn’t get some of the big items they wanted in the latest COVID-19 relief legislation, but they didn’t get some punishing proposed provisions either.

On March 10, the House of Representatives passed a reconciled version of the $1.9 trillion COVID-19 relief bill known as the American Rescue Plan. In a statement that day, President Biden announced his intention to sign the bill into law on March 12. The legislation contains the high-profile $1,400 stimulus checks for a significant majority of Americans, but it contains many measures affect home health and hospice agencies.

Near miss: A proposed provision of serious concern to home care providers was a minimum wage hike to $15 per hour. “An increase to the federal minimum wage has long been a challenging issue for home care and hospice providers, as they seek to balance the need to properly reward the indispensable work of caregivers with inadequate payment rates that make it difficult to maintain any profit margin,” the National Association for Home Care & Hospice recently said. But in the final version, the minimum wage hike was dropped.

Unfortunately for providers, another provision that didn’t make the bill was an extension of the sequestration suspension. Thus, Medicare providers’ holiday from the 2 percent pay cut will end on March 31. One publicly traded home health chain recently noted that the sequestration suspension resulted in an addition of $23 million to its revenues in 2020 (see HCW by AAPC, Vol. XXX, No. 9).

One element that did make it into the bill is $8.5 billion allocated “for purposes of making payments to eligible health care providers for health care related expenses and lost revenues that are attributable to COVID–19” in rural areas, the legislation specifies.

The funds will go to providers “who are enrolled in Medicare or Medicaid and provide diagnosis, testing or care for individuals who may or do have COVID-19, including home health, hospice and long term services and supports providers as well as nursing homes,” notes trade group LeadingAge in a release.

“Eligible rural providers will need to submit an application for the new Provider Relief Fund provision, including documentation of actual healthcare-related expenses and lost revenues attributable to the COVID-19 pandemic,” notes law firm McGuireWoods in online legal analysis.

The National Association for Home Care & Hospice “appreciates Congress’ continued work towards meeting the demands of the pandemic,” the trade group says in a statement shared with AAPC. “The increased Provider Relief Funding for rural providers will prove to be a lifeline for patients and providers alike to continue care delivery in rural areas.”

Plus: “NAHC appreciates the late change on this provision extending eligibility to providers that serve rural areas, not just those located in rural areas,” according to the release.

HCBS Boost Welcome

Another financial boost comes from “a one-year, 10 point increase in the federal share of Medicaid spending for home and community-based services (HCBS),” LeadingAge points out. “The text includes state plan home health and personal care, PACE services, and waiver services (like adult day) as services eligible for this increased federal match.”

State agencies will get the funds and then have discretion over how to use the dollars, LeadingAge explains. “Critically, however, the American Rescue Plan requires that states actually use these dollars for their HCBS programs and not for other purposes.”

“The dedicated funding for Medicaid home and community based services will ensure home care recipients can continue to receive care in the safest possible environment, their home,” NAHC praises.

The bill also allocates an additional $7 billion for the PPP program, notes law firm Holland & Knight in a summary of the legislation. But most of that will go toward expanding coverage for other types of borrowers

However: One change could help home care and hospice agencies that are part of larger, nonprofit organi­zations. “Under current PPP rules, most organizations must employ 500 workers or fewer to be eligible, regardless of how many locations they operate,” LeadingAge says. “The American Rescue Plan would shift this policy for not-for-profit organizations and allow larger not-for-profit organizations to receive a PPP loan if they have 500 workers or fewer in each physical location they operate.”

For example: “A not-for-profit multisite aging services organization that has a nursing home with 300 workers, an adult day services program with 20 workers and a home health agency with 350 workers currently cannot get a PPP loan because it has 670 workers. Under the American Rescue Plan, however, it would be eligible because each of its locations has fewer workers than the limit of 500,” LeadingAge offers.

The law also appropriates $15 billion to the Small Business Administration to provide Economic Injury Disaster Loan (EIDL) $10,000 grants to small businesses eligible under the CARES Act, Holland & Knight adds.

Many billions will go to shoring up public health and vaccination infrastructure.