Bipartisan Bill Seeks Home Care Pilot

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Rhonda Oakes By Rhonda Oakes 
RN, CHPN, Regulatory Analyst, Change Healthcare
Bipartisan Bill Seeks Home Care Pilot

A bipartisan bill has been re-introduced in the U.S. Senate that would fund a Medicare pilot for home healthcare to keep people from costlier post-acute care settings such as nursing homes. Passage is uncertain given current efforts to repeal and replace the Affordable Care Act, but the bill already is gaining support from the homecare community.

Senators Chuck Grassley (R-IA) and Ben Cardin (D-MD) envision that the five-state pilot would target Medicare-only participants needing help with two or more activities of daily living (ADLs), the threshold for a potential nursing home stay. The bipartisan bill would create a new Community-Based Institutional Special Needs Plan (CBI-SNP) demonstration.

The comforts of home

“I’ve never met anyone who can’t wait to move into a nursing home,” Grassley said in a news release announcing the legislation. “Everybody wants to stay in their own homes as long as they can, with the comforts of home. Unfortunately, our current system doesn’t have a bridge for those who are on a fixed income but would have to sell their house to become eligible for Medicaid and get nursing home care. Our bill sets up a demonstration project to build a bridge for those who need care but otherwise would have to go to a nursing home to get it.”

The stated goal of the program is to keep Medicare beneficiaries in their homes by providing individualized services, such as help with such ADLs as bathing and dressing, housekeeping or transportation. The proposal also would provide for respite care for primary caregivers.

According to the news release, one estimate projects nearly $60 million in savings over a four-year period, based on 5,000 pilot participants delaying or preventing stays in the hospital or a nursing home.

Support from industry

William Dombi, vice president for law at the National Association for Home Care & Hospice, calls the bill a “holistic approach” that acknowledges “there are multiple factors at play in a person’s health and care that go beyond traditional health services,” according to coverage by The Hill.

The pilot would incorporate coverage into commercial Medicare Advantage plans in five states for up to 5,000 participants. The demonstration would need $3 million in seed money, according to the article.

Joe Caldwell, director of long-term services and supports policy at the National Council on Aging, said in the same article that private payers are already exploring alternative methods, such as at-home help to keep plan participants out of institutional settings. He also noted that the Centers for Medicare & Medicaid Services has previously looked at expanding at-home services used by dual-eligible beneficiaries to other groups that could benefit.

Grassley and Cardin introduced nearly identical legislation during the last session of Congress that did not pass. The odds certainly remain long this time, with the current focus on other matters in Congress.

But it’s heartening to see recognition of the home care industry for the central roles we all play in keeping patients out of higher-cost, higher-acuity care settings when appropriate.

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