A new spending bill passed Tuesday by the House of Representatives to keep the federal government running through March 23, 2018, includes several provisions that impact home health, hospice, and Nursing Homes. The Senate is expected to unveil its own spending bill, possibly as soon as today. A final version will then be negotiated between the two chambers before being passed.

The good news is the House version of the continuing resolution includes:

  • The CHRONIC Care Act, which could make it easier for Medicare Advantage enrollees to pay for telehealth services. The CHRONIC Care Act would also expand the use of telehealth for treating and diagnosing strokes, especially in cases where immediate virtual care could minimize damage. Also includes Section 2301: Extending the Independence at Home Demonstration Program; Section 2313: Increasing convenience for Medicare Advantage enrollees through telehealth; Section 2315: Expanding the use of telehealth for individuals with stroke; and Section 2314: Providing accountable care organizations (ACOs) the ability to expand the use of telehealth.
  • Section 2113: Repeal of Medicare payment cap for therapy services; replacement with limitation to ensure appropriate therapy. The repeal costs $6.4 billion, and is paid by offsets.
  • Includes Section 2104: Extension of home health rural add-on. Medicare provides increased payments under the home health (HH) prospective payment system (PPS) for home health care provided to beneficiaries in rural areas. MACRA extended the 3-percent Medicare HH PPS rural add-on through December 31, 2017. This section would provide a 5-year extension of this policy with reforms until October 1, 2022. However, the reforms in this section include a new methodology to target the add-on payment to those areas with a population density of 6 or fewer individuals per square mile, which could reduce the number of agencies receiving the add on.
  • Section 2202: Information to satisfy documentation of Medicare eligibility for home health services. This section allows the Secretary to utilize the medical records of home health providers, in addition to the medical records of physicians, when determining a patient is eligible for home health services.
  • Section 2203: Voluntary settlement of home health claims. This provision addresses denials of Medicare payment for home health services. After a denial, providers have the right to appeal the decision, but the Medicare appeals backlog has grown at an unsustainable level and the Secretary is not able to process appeals in a timely manner. This section gives the Secretary authority to enter into a voluntary settlement with home health providers to clear some of the appeals backlog.

The bad news is the House version of the continuing resolution includes:

  • Section 2201: Home health payment reform. This section requires the Secretary to reform the current home health payment system, beginning January 1, 2020. The Secretary is required to implement a 30-day episode for payment. We are pleased that this change is required to be budget neutral; however, the reintroduction of the home health groupings model (HHGM) is a major concern for us. LeadingAge participated in a technical advisory panel on HHGM, and there were many questions raised for consideration and more analysis that needs to be completed.
  • Section 2702: Home health market basket reduction. This section would require the FY2020 market basket update for home health agencies to be 1.4 percent, a $3.5 billion offset. In absence of this section, the home health market basket would be higher.
  • Section 2701: Payment for early discharges to hospice care. This section adds hospice, as a setting of care, to the existing post-acute care transfer policy. Under the policy, hospitals would be paid less when the hospital transfers a patient to hospice, if that patient had a short length of stay in the hospital. The policy only applies in those cases where the patient falls into one of the top ten reimbursed hospital stays. The policy would begin on October 1, 2023.

Lawmakers must strike some sort of budget deal and pass legislation by Feb. 9 to avoid another short-term government shutdown.