Don’t Fret over Co-Pay, Reimbursement Proposals

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By Terry Miller, RN 
Regulatory Advisor, McKesson

Home Health Agency Reiumbursements CutThe home health and hospice industries may face continued reimbursement cuts and homecare co-pays starting in 2017 if President Obama’s latest federal budget proposal is enacted.

CMS and the administration have either suggested or implemented a host of changes to rein in healthcare costs overall, but a lot can happen between now and when the $100 co-pay would take effect. Under the proposal, Medicare beneficiaries may be required to pay a $100 co-pay for more than five home health visits that didn’t start with a hospital or post-acute inpatient stay.

This proposal and others – such as reductions in Market Basket Index updates, home health rate rebasing in 2014 and productivity adjustments the following year – certainly require close monitoring. The National Association for Home Care & Hospice “strongly opposes the Obama Administration’s proposed home health copayments,” the organization stated in a news release.

It’s interesting to note that home health and hospice are among the Medicare benefits that do not currently carry a co-pay. However, co-pays could hinder access for a significant percentage of homecare users. It’s also true that home health agencies and, to a lesser extent, hospice agencies have been enduring painful reimbursement cuts for years.

But the 2017 budget may be more of a stop-gap measure, and many of these proposals likely will be significantly altered or eliminated in the meantime. CMS and its Center for Medicare & Medicaid Innovation have invested billions in pilot programs that address new care models, payment methodologies, care transitions and much more. Home health can be an integral part of these programs.

That’s not to say that the industry shouldn’t keep close tabs on actions in Washington that could impact it. But overall, we should continue doing what we do best – and that’s taking great care of our patients while helping them stay in their homes.

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