Home Health & Hospice Week

Budget proposal follows up on State of the Union remarks.

The value-based purchasing and oversight provisions in the Biden administration’s newly unveiled budget for 2025 could pack a wallop for home health and hospice agencies, but many other sectoins carry potential impacts as well.

Other home health and hospice topics addressed in the budget include:

HCBS: The budget calls for “$150 billion over 10 years to strengthen and expand Medicaid home and community-based services, allowing elderly and individuals with disabilities to remain in their homes and stay active in their communities, and improving the quality of jobs for home care workers,” the White House says in its budget overview document.

The proposal is “consistent with President Biden’s comments in his State of the Union address,” notes Noah Block with Ancor in the trade group’s rule analysis. “The president recognizes that more than three-quarters of home and community-based service providers are not accepting new clients,” Block maintains.

In the State of the Union speech, the president offered this statement: “Imagine a future with home care and elder care so seniors and people living with disabilities can stay in their homes and family caregivers get paid what they deserve. Tonight, let’s all agree … to stand up for seniors.”

The National Association for Home Care & Hospice and its members “are very grateful that once again the President has highlighted the crucial importance of home care in his State of the Union speech. Our country has a growing need for home care as an essential support for persons with disabilities and the infirm elderly. The caregivers who attend to our highly vulnerable family and friends also deserve our highest level of respect,” NAHC President William Dombi says in a statement.

“We are pleased that the President is continuing his commitment to expanding access to these vital services … that allow those who choose to remain in the community,” says trade group LeadingAge in its budget analysis. “This proposal mirrors the Better Care Better Jobs Act (S. 100/H.R. 547) that was reintroduced in Congress last year,” it adds.

Cybersecurity: With the incredibly disruptive UnitedHealthcare Group/Change Healthcare ransomware attack top of mind (see story, p. 77), the Department of Health and Human Services calls for increased funding to tighten up cybersecurity. “From 2018 to 2022, there was a 95 percent increase in large data breaches reported to HHS, including ransomware attacks,” the agency says in its budget brief. “HHS seeks to bolster the Department’s cybersecurity capabilities to protect vital healthcare information both in the sector and at HHS, which remains a target for cybercriminals.”

That includes $1.3 billion in financial incentives to assist hospitals in defending against cyberattacks, the American Hospital Association reports.

Private equity: The administration continues to look for ways to protect the healthcare industry against private equity abuse, including increasing transparency — and reporting requirements — for nursing home providers, the budget documents show. Expect to see that spread to other provider types, experts say.

Labor provisions: The administration also calls for expansion of worker protections, including “a national, comprehensive paid family and medical leave program administered by [the Social Security Administration] to ensure that all eligible workers can take up to 12 weeks” of family leave or “up to three days to grieve the death of a loved one,” the White House budget overview notes.

And “the President continues to call on Congress to require employers to provide seven job-protected paid sick days each year to all workers, and ensure that employers cannot penalize workers for taking time off ” for protected reasons, the budget document adds.

Cancer care quality: The administration proposes to create “a cancer care quality data reporting program for all Medicare providers,” HHS says in its “Budget in Brief ” document. Among other things, that will likely mean new cancer care quality measures that may apply to hospices, observers expect.

Missing: “The budget is an opportunity for the administration to show Congress and the public what it really cares about,” highlights health policy advisor Jeffrey Davis with McDermott+Consulting. That means “omissions can provide an indication of issues the Administration chose to de-prioritize during this election year,” Davis points out in the firm’s Regs & Eggs regulatory blog.

For home health providers, the most interesting omission may be the hospital-at-home waiver program. “At the end of this calendar year, major Medicare waivers put in place during the COVID-19 public health emergency (PHE) are set to expire, including the Medicare telehealth waiver and the hospital-at-home program,” Davis notes. “The hospital-at-home model is … extremely popular” and “many stakeholders have repeatedly pushed Congress to extend the [waiver] long term,” but they are not mentioned in the budget.

Another missing element is site-neutral payments, Davis adds.

Note: The 188-page White House budget overview document is at www.whitehouse.gov/wp-content/uploads/2024/03/budget_ fy2025.pdf.