Home Health & Hospice Week

Advisory body predicts 14.5 percent profit margin for HHAs in 2011.

Yet another barrier to home care access could come your way, if Congress listens to a recommendation from an influential advisory body.

As it voted to do in January, the Medicare Payment Advisory Commission has recommended a copayment for home health agency services in its March report to Congress. A $150 copay for a home health episode would be a good deal for beneficiaries, MedPAC contends in its report. "For the average episode payment of about $3,000 in 2008, Medicare would pay about $29 in benefits for every $1 the beneficiary paid," it says.

That copay amount would be significantly less than hospital or skilled nursing facility copay levels, MedPAC notes in the report. The copay would also apply to only about one-third of home health patients -- those with episodes that don't follow a hospital or post-acute stay or that are low-utilization payment adjustment (LUPA) episodes of four visits or less.

A home health copay would encourage "appropriate use" of the benefit, MedPAC contends.

Response: Industry representatives have come out fighting against the copay proposal. "The Visiting Nurse Associations of America ... strongly opposes reinstatement of copayments for the home health benefit," VNAA says in a release.

"A majority of beneficiaries have already faced other copayments and deductibles for doctors or institutional care," VNAA's Andy Carter says in the release. "Asking them to make an additional co-payment is a counterproductive added burden that will impede access to medically necessary care." And it could land patients in the hospital, because they are avoiding the cost of home care.

A HHA copay "could set back ongoing efforts to care for America's most vulnerable citizens," the National Association for Home Care & Hospice says. "Requiring seniors and disabled Americans to pay a fee to access home health care is nothing more than a 'sick tax' that falls heaviest upon the sickest, poorest, and most vulnerable members of society, impeding their ability to access home health services."

MedPAC also urges Congress to keep HHAs' payment levels flat in 2012, instead of granting an inflation update. "Medicare continues to overpay for home health services," the commission maintains in the report.

Note: The report is at http://www.medpac.gov/documents/Mar11_EntireReport.pdf. Chapter 8 covers HHA recommendations.