Strengthening and underpinning the safety-net to aid individuals needing care act of 2018, also called the “SUSTAIN Care Act of 2018”—I like the sound of this because it leads me to believe access to care will be less of an issue for the most vulnerable among us.
Bloomberg reports that Americans spend more than $300 billion per year on long-term care, including nursing homes, assisted living facilities and in-home care—six times the annual budget of the U.S. Department of Housing and Urban Development. The total would be far higher if it accounted for gray-market domestic work or the country's 21 million unpaid family caregivers.
The National Association for Home Care & Hospice (NAHC) cites victories for the homecare and hospice community in this week’s federal budget guide that details the SUSTAIN Care Act. Some, however, are waiting to see the exact language of what was passed in the wee hours of February 9, 2018 and the details that are still to come.
Prior to Friday’s action, summaries of the measures, as well as estimated direct spending effects, were posted February 5 and 6, 2018, as was the 652-page bundled Bipartisan Budget Act of 2018 document, which included extending the Children's Health Insurance Program (CHIP) through fiscal year 2027. If you take a look at these .gov texts, you’ll have tons of information to digest for homecare industry news.
The many provisions are still to be hammered out in near-term committee hearings toward the final budget. Numerous Medicare policies, including doing away with the dormant Medicare Independent Payment Advisory Board (IPAB), are heavily imbedded. Many are related to homecare including:
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.
Section 2113: Repeal of Medicare payment cap for therapy services; replacement with limitation to ensure appropriate therapy, but continue to require that an appropriate modifier be included on claims over the current exception threshold indicating that the services are medically necessary, and it would lower the threshold for the targeted manual medical review process from $3,700 to $3,000.
Section 2121: Providing continued access to Medicare Advantage special needs plans for vulnerable populations. Congress has extended SNPs several times, but the most recent extension (which was included in MACRA) expires on January 1, 2019. This section permanently reauthorizes SNPs, along with a number of reforms to D-SNPs and C-SNPs that will improve care management.
Section 2122: Extension of certain MIPPA funding provisions; State health insurance assistance program reporting requirements. Congress has extended programs for outreach, counseling and information assistance to Medicare beneficiaries several times, the most recent extension included in MACRA, expired on September 30, 2017. This section reauthorizes these programs for two years through September 30, 2019.
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. This change is required to be budget neutral.
>> Audio: Kaiser Health News highlights: "an awful lot of health care in that package."
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. In recent years, 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.
Section 2207: Revised requirements for Medicare intensive cardiac rehabilitation programs. This section allows for updated guidelines for qualification to be a provider of intensive cardiac rehabilitation (ICR).
>> Forbes contributor Howard Gleckman offers thoughts in a tidy, helpful summary.
On Chronic Care Management
Chronic care management (CCM) is seen as a field that is growing rapidly. The highest health care utilizers are becoming a bigger focus of payers and emerging CCM providers. Included under this heading:
Section 2301 extending the Independence at Home Demonstration Program.
Section 2302 expanding access to home dialysis therapy.
Section 2311 adapting benefits to meet the needs of chronically ill Medicare Advantage enrollees.
Section 2312 expanding supplemental benefits to meet the needs of chronically ill Medicare Advantage enrollees.
Section 2313 increasing convenience for Medicare Advantage enrollees through telehealth.
Section 2314 providing accountable care organizations (ACOs) the ability to expand the use of telehealth.
Section 2315 expanding the use of telehealth for individuals with stroke.
Section 2332 for a study on the development of a payment code describing the formulation of a comprehensive plan of longitudinal care for a Medicare beneficiary diagnosed with a serious or life-threatening illness, such as Alzheimer’s disease and other dementias, cancer, and neuromuscular disease.
Section 2341 for a study and report on improving medication synchronization to address the issue of multiple prescriptions in patient populations.