House Passes Legislation Extending Home-Based Demonstration Model
July 16, 2015 09:21 AM
The US House of Representatives on Wednesday, July 15, passed legislation extending for an additional two years a home-based demonstration model implemented under the Affordable Care Act. The Independence at Home Medical Practice Demonstration Improvement Act (S. 971) extends for an additional two years the Independence at Home program focusing on certain high-risk patients with chronic illnesses.
The House passed the legislation by voice vote. As previously reported, the US Senate passed the legislation in April. The bill was introduced by Senator Ron Wyden (D-OR), along with cosponsors Senator Edward J. Markey (D-MA), Senator Michael Bennet (D-CO), Senator Richard Burr (R-NC), and Senator Johnny Isakson (R-GA). Following the Senate vote, the House Ways and Means Committee approved the legislation allowing consideration of the bill on the House floor.
The Independence at Home model uses home-based primary care teams directed by physicians and nurse practitioners to treat Medicare beneficiaries with chronic conditions. The demonstration tests a service delivery and payment model that provides incentives to teams based on their performances improving health outcomes and reducing expenditures. The reimbursement method shares Medicare savings between Medicare and participating providers.
The project has proven successful so far in showing the benefits of caring for people in their homes. In June, the Centers for Medicare & Medicaid Services (CMS) announced Independence at Home had resulted in over $25 million in Medicare savings during its first performance year, as well as fewer hospital readmissions and higher quality care. In announcing the success, CMS Acting Director Andy Slavitt stated that the “results support what most Americans already want—that chronically ill patients can be better taken care of in their own homes.”
Val J. Halamandaris, President and CEO of the National Association for Home Care & Hospice (NAHC), has commended Independence at Home, as well as the sponsors of the legislation, for focusing on and highlighting the benefits of caring for people in their homes. NAHC supports the Independence at Home Demonstration model, while also advocating for an expanded focus on chronic care management with a broader population than covered under Independence at Home. Halamandaris called the demonstration “a good step in what needs to be an increased focus on home- and community-based care.” The next step, he said, is for Congress to “establish a separate care management benefit under Medicare for those with chronic conditions.”
NAHC recommends the separate care management benefit should include those with chronic obstructive pulmonary disease, congestive heart failure, diabetes, and certain neurological disorders. In order to ensure a discipline-integrated, community care-based approach to care management, the service should be provided by professional nurses and others within home health agencies, under the guidance and supervision of the patient’s attending physician as a member of the care team. The services should include: 1) An interdisciplinary team approach to care management that includes physicians, nurses, therapists, medical social workers, and pharmacists; 2) Evidence-based care plan development; 3) Direct patient care services in the home setting; 4) The application of telehealth services for appropriate remote monitoring as needed by the individual patient; 5) Care counseling, care coordination, medication management, and oversight of services related to activities of daily living; 6) The use of interoperable electronic health care records and efficient electronic-based communication tools; 7) Patient education and support; and 8) Integration and support of informal caregivers such as family members.
More information about Independence at Home is available here.