Home Health & Hospice Week

Therapy caps, Medicare Advantage changes also impact home care.

The newly enacted requirement for home health payment reform may be budget neutral, but other parts of the bill are not.

Case in point: A section of the law requiring a case-mix update reduction will strip about $3.5 billion from Medicare home health spending over 10 years, the Congressional Budget Office estimates, according to LeadingAge.

The cut puts home health agencies in the "loser" category for the law, judges Politico.

This provision is one of the only home health sections to undergo changes between the House-passed version of the bill and the legislation that ultimately became law.

Former: The House-passed bill reduced the 2019 payment update to 1.4 percent in 2019.

Latter: The final law reduced it to a slightly higher 1.5 percent a year later, in 2020.

"Actually, the 1.5 percent increase that will occur in 2020 is better than previous years," LeadingAge notes. However, "this change is not written in stone," the association adds.

The combination of Medicare Payment Advisory Commission recommendations for steep cuts, such as this year's 5 percent chop (see Eli's HCW, Vol. XXVII, No. 2), and pressure on lawmakers to find money-saving solutions could culminate in further cuts required by Congress.

Other Bipartisan Budget Act provisions that will affect home care providers include:

• Medicare Advantage plan changes. Under the law, Medicare Advantage plans may furnish "supplemental benefits that, with respect to a chronically ill enrollee, have a reasonable expectation of improving or maintaining the health or overall function of the chronically ill enrollee and may not be limited to being primarily health related benefits."

This builds on the Centers for Medicare & Medicaid Services' recently announced proposal to allow "non-skilled inhome supports" in Medicare Advantage plans in 2019 (see Eli's HCW, Vol. XXVII, No. 7). Thirty percent of Medicare beneficiaries are now enrolled in MA plans, reports Forbes.

•  Therapy caps. Home care providers that furnish outpatient therapy in the home under Part B will be glad to see the current exceptions process for the caps extended permanently. The move is a de facto elimination of the caps, advocates say. Under the current process, providers use the KX modifier to attest medical necessity when a patient's therapy costs exceed the cap for the year ($2,010 for 2018).

"Ending the hard cap has been a high priority for the American Physical Therapy Association since its introduction in 1997," APTA says.

However: "The bad news is that Congress chose to offset the cost of the permanent fix (estimated at $6.47 billion) with a last-minute addition of a payment differential for services provided by physical therapist assistants (PTAs) and certified occupational therapy assistants (COTAs) compared with payment for the same services provided by physical therapists (PTs) and occupational therapists (OTs), respectively," APTA explains in a release. "The payment differential, which was strongly opposed by APTA and other stakeholders, states that PTAs and OTAs will be paid at 85 percent of the Medicare physician fee schedule beginning in 2022." The trade group vows to fight the pay differential going forward, particularly in light of the therapist shortage affecting many areas of the country.

Reminder: Therapy caps affect only outpatient therapy furnished under Part B, not therapy provided under a home health plan of care.

Home infusion. The law puts in place a "temporary transitional payment" system for home infusion providers. The system will create three categories of drugs.

The change will create "stability for home infusion therapy providers," the National Association for Home Care & Hospice says. "Due to ongoing payment reforms that started in 2017 and won't be fully implemented until 2021, home infusion therapy providers were put on unsteady ground."

• IAH. The law extends the Independence at Home demonstration by two years.

Note: See the law's text at www.congress.gov/bill/115th-congress/house-bill/1892/text.