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Copayments Are Reintroduced to the Reluctant Home Health Care Industry

Posted on Tuesday, August 23, 2016 1:48 PM

Copays, which were eliminated from Medicare several decades ago, are reintroduced as early as 2018 for the home health care industry. Some people are referring to it as doomsday. Unless, home care advocates can shift the momentum around copayments in Washington.

The Council of State Homecare Association and the Pennsylvania Homecare Association recently held a public policy summit and “advocacy day on the hill” in Washington D.C. to discuss the following goals:
• Prevent the implementation of a home health care copayment
• Repeal the rebasing cuts from the Centers for Medicare & Medicaid Services
• Utilize a targeted enforcement approach to combat fraud.

Since the pre-claim demonstration is already underway, home care groups and industry leaders are focusing their lobbying efforts on copayments. The industry groups have continued to oppose the idea of bringing back copayments, which were eliminated more than 40 years ago. However, copayments have been reintroduced in President Obama’s budget proposals for years.

“Congress eliminated the home health copayment in 1972 for the very reasons it should not be resurrected now,” the National Association for Home Care & Hospice (NAHC) wrote in comments to House Ways and Means Committee back in 2013. “The home health copayment in the 1960s and the 1970s deterred Medicare beneficiaries from accessing home health care and instead created an incentive for more expensive institutional care.”

“We met with Medicare, CMS, and MACs locally,” Constance Morrison, president and CEO of Berks Visiting Nurse Association (VNA), Pottstown VNA and Advantage Home Care, said of the advocacy day in July on Capitol Hill. “We were able to probe and educate others about things that are coming down the pike in the industry. We were able to lobby, throw tomatoes. There were 19 states represented, and about 130 people representing home care.”

Berks VNA and Pottstown VNA are Pennsylvania-based registered non-profit home and community based health care services providers that are externally managed by their parent company, Home Health Care Management, Inc.

Morrison spoke on behalf of Pennsylvania residents. She addressed her goals to expand access to “top-notch, affordable home health care” to Capitol Hill. The following remarks were made by Morrison:
• “The home health benefit is such a valuable piece of Medicare altogether,” Morrison said. “It was really clear across the board [at the meeting] that, big or small, we were all on the same page that this is a terrific benefit. We should not make cuts, not add a co-pay because then there will never be services.”
• “We asked our legislators to support [new ways of targeting fraud] instead of washing us all in the same bathwater,” Morrison told HHCN. “We can do targeted fraud prevention. For the rest of us, the rules must be suitable.”
• “As part of the ACA, one of the ways to limit or make people responsible for their home care and cut costs is not just have Medicare pay for the 60-day episode,” Morrison said. “Right now, we aren’t sure what [the copayment] will look like, but likely $100 for every 60-day episode.”
• “We know that people who have copays and have to choose between medication or food will choose food,” Morrison said. “If it’s home care versus medication, they will choose medication. It’s not a good topic.”

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