Health Care Reform and Home Care: What We Know Today

On Sunday, March 21st the US House of Representatives passed historic Health Care Reform Legislation.   The bill that passed is that which emerged from the Senate Finance Committee and that passed the Senate at the end of 2009.   As has previously been reported,  the Senate version of reform has been – for home care – less damaging than bills that had previously passed the House. While indications are that there may be some changes to Medicare provisions in the “reconciliation” bill being debated this week in the Senate, there is no indication that there will be changes to the home care language.  What we should expect for home care will be:

• A delayed and phased approach to rebasing of home health payments (rebasing would begin in 2014 and be phased in over four years, as compared with the House’s proposal of complete rebasing in 2011);

• Rejection of the Medicare Payment Advisory Commission’s proposed acceleration to 2010 of the 2011 case-mix creep adjustment;

• Preservation of the full market basket update for 2010, with 1 percentage point reductions off the market basket in 2011, 2012, and 2013

• Reinstatement of the rural payment differential (add-on) at 3 percent from April 1, 2010 until Jan. 2, 2016.

The federal long term care program – the CLASS act – is in,  as are demonstration and pilot programs for providing chronic care management, transitions in care, and post-acute care management.  All of these should involve home care.

Additionally, effective in 2014, employers of more than 50 people will be required either to provide coverage or pay a penalty for not offering health insurance to employees. (It is unclear at this point how federal insurance mandates will be handled in relation to the Massachusetts mandates already in place.)

The National Association for Home Care has called the bill “a combination of new opportunities for home care — and threats to the viability of the home health services community.”

With many of the home care cuts  delayed, and demonstration projects to help shape, we will need every voice in Washington to make sure our issues continue to be heard above the continuing health care reform roar.

Author: Pat Kelleher

Pat Kelleher is Executive Director of the Home Care Alliance of Massachusetts.

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