New Bills Introduced on Home Health, Workforce, Medical Expense Deduction

Legislation | May 21, 2019 | by Barbara Gay

Several bills recently introduced in Congress would benefit aging services providers and those they serve.

Home Health:

The Home Health Payment Innovation Act of 2019, H.R. 2573, would preserve Medicare recipients' access to home health services and provide a pathway for innovative approaches to using these services. The bill, cosponsored by both Democrats and Republicans, would prevent unwarranted payment rate cuts by basing any behavioral adjustment on actual evidence and limit the risk of disruption in care by providing a phase-in for any necessary rate increases or decreases.

The legislation would revise a provision of the Patient Driven Groupings Model (PDGM) Medicare home health payment reform rule CMS issued last fall. In issuing the rule, CMS followed the  requirements of the Bipartisan Budget Act of 2018 by building in an assumption that home health agencies will change documentation and coding practices under PDGM, putting the highest-paying diagnosis code as the principal diagnosis code in order to have a 30-day period placed into a higher-paying clinical group. The rule also assumes home health agencies will take advantage of changes to co-morbidity coding and Low Utilization Payment Adjustment (LUPA) thresholds. In sum the model would reduce payments by 6.47% prospectively because of the statutorily mandated assumptions that providers will automatically change behaviors. LeadingAge believes that any adjustments to home health Medicare reimbursement rates ought to be based on observed behavior not presumed behavior. Accordingly, we along with ElevatingHome and VNAA support H.R. 2573.

Workforce: 

The Educating Medical Professionals and Optimizing Workforce Efficiency and Readiness (EMPOWER) for Health Act, H.R. 2781, would reauthorize federal health care workforce programs under Title VII of the Public Health Service Act. The legislation, which has bipartisan sponsorship, would preserve the Geriatrics Workforce Enhancement Program. This program provides grants to geriatric education centers to educate and train doctors, nurses, social workers, and other health care professionals in the care and treatment of older people who often have a variety of chronic health conditions and who may not respond to treatments in the same ways that younger people do. The bill also would resurrect the Geriatric Academic Career Awards program, which promotes the development of a professional force of clinicians to train the aging services providers of the future. Funding for these programs would be raised to $51 million under the legislation. As a member of the Eldercare Workforce Alliance, LeadingAge strongly supports this bill.

Medical Expense Deduction: 

When Congress passed the Tax Cuts and Jobs Act of 2017, we fought for provisions to preserve the income tax deduction for medical expenses and to lower the deduction threshold to 7.5% of adjusted gross income. Unfortunately, this threshold level expired at the end of 2018, and the threshold for the deduction has returned to 10%.

People aged 65 and over often have high out-of-pocket medical expenses relative to their incomes. Thousands of them will end up paying far higher taxes unless the lower threshold is extended. Residents of life plan communities can use this deduction for a portion of their entry and/or monthly fees that qualify as medical expenses, making this form of medical care in their retirement housing far more affordable for many older adults.

Earlier this year, Senators Charles Grassley (R-IA) and Ron Wyden (D-OR) introduced S. 617, the Tax Extender and Disaster Relief Act, which would restore and make permanent the 7.5% threshold for the medical expense deduction permanent. As the Chair and Ranking Member of the Senate Finance Committee, Senators Grassley and Wyden have just appointed bipartisan task forces to examine the 42 so-called "tax extenders", tax provisions that have expired or will expire by the end of this year. The 7.5% threshold for the medical expense deduction is included among the tax extenders to be evaluated. LeadingAge will continue advocating for this vital tax provision that benefits many older people.