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Voluntary Nonprofit Home Care Association of America

Legislative Action Network


Melissa Jeremiah, RN, CHCE, Director of Operations
Hoosier Uplands Home Health Care & Hospice

We have all fallen over the fiscal cliff, and bounced back up onto the ledge. What does this mean to home health and hospice, and the citizens we serve?!?

Home health & hospice are almost certain to face a 2% cut in their Medicare payments beginning 04/01/13, due to sequestration. All home health & hospices need to have their billing caught up, as we are not 100% certain whether the 04/01/13 date means episodes beginning on 04/01/13, or episodes paid after 04/01/13.

However, in my opinion the most dangerous threat to home health and hospice, and the citizens we serve, is the talk of adding a copay to Medicare beneficiaries who seek home health & hospice services. As we get deeper into the year we need to speak up and oppose any bills that consider a copay as a solution to fix our nation's fiscal crisis, on the backs of our most vulnerable citizens.

President Obama's 2013 budget recommendations call for a home health copay beginning in 2017. The President recommends a $100.00 copay to "encourage appropriate use" of home care for episodes that are not preceded by inpatient care and for episodes with five or more visits. I seem to recall the intent of the home health face to face was to ensure appropriate use of home health for all new Medicare episodes.

The Simpson-Bowles reduction plan recommends a 20% Medicare copay for all services, including home health and hospice. The 20% copay for home health would mean $600.00 per 60 day episode of care. The average cost for hospice recipients is over $10,000, meaning their copay would be more than $2,000.00. Again I point to the home health and hospice Medicare face to face requirements, that were intended to ensure appropriateness of services utilized.

Home health and hospice have been proven to be cost effective health care delivery systems. The push is also on to decrease re-hospitalizations of Medicare patients. This would be the worst time to institute a copay, as the goal of decreasing re-hospitalizations and having patients not being able to afford home health and hospice are contradictory in nature.

I have heard time and time again that Medicare recipients need to have some skin in the game, but I think a copay would be asking them to place blood in the game.

Voluntary Nonprofit Home Care Association of America
228 Seventh Street, SE Washington, DC 20003
(202) 547-7424

An Affiliate of the National Association for Home Care & Hospice

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