MedPAC Solidifies 2016 Payment Recommendations for Home Health, Hospice
January 28, 2015 11:12 AM
In mid-January, the Medicare Payment Advisory Commission (MedPAC) met to finalize recommendations for inclusion in its annual March Report to Congress on Medicare payment policy. In arriving at its recommendations, the commission examined a variety of factors that relate to payment adequacy - including beneficiary access to care, the capacity and supply of providers, care utilization, quality of care, provider access to capital, and financial margins. In December MedPAC staff explored issues related to hospice payment adequacy in depth, and which was covered in NAHC Report here. For both home health and hospice, MedPAC will recommend that Congress eliminate the updates for the 2016 payment year, and will reprint recommendations from previous reports that have not been implemented. As the annual payment updates for both home health and hospice are set in statute, elimination of the payment updates for 2016 would require legislative action.
Relative to hospice payment policy, MedPAC has continuing concerns that previous recommendations related to hospice payment reform and oversight of hospices that have a high proportion of long-stay patients have not yet been implemented. For this reason, MedPAC plans to reprint these recommendations as part of the hospice chapter of the March Report. It should also be noted that as part of its 2014 March Report to Congress, MedPAC recommended that hospice be included as part of the Medicare Advantage benefit package. For more on that recommendation, please see NAHC Report, January 24, 2014.
With respect to home health - in addition to its recommendation that no payment update for the 2016 payment year should be included - MedPAC is expected to include the following recommendations in its forthcoming Report: that the Centers for Medicare & Medicaid Services (CMS) implement the remaining two years of home health payment rebasing during the 2016 payment year; that CMS revise the home health case-mix model to rely on patient characteristics to set payment levels and redistribute monies to non-therapy services; that CMS identify the types of patients that might best benefit from home health services and develop quality outcome measures for each such category; that a per-episode copayment be assessed for home health care that was not preceded by a hospital or skilled nursing facility stay (dual eligible patients would not be subject to the copay; recommended copay level of $150 per episode); and that payments to home health agencies with relatively high risk-adjusted rates of hospital readmissions be reduced.
NAHC will continue to follow MedPAC’s recommendations and how well they are received by Congress.