Next week, Home Care Alliance members will be in Washington DC to make sure that our elected federal officials understand the role of home care in the health care delivery system and the strain on services being imposed by new federal rules, such as the face to face requirement. We will also be seeking their help in carrying our message to those unelected federal officials who run the Medicare program for the Congress and the American people: the Centers for Medicare and Medicaid. With both enormous responsibility and authority, this federal agency can hugely influence who gets and who provides health care.
In advance of our meetings, the Home Care Alliance sent a letter to United States Secretary of Health and Human Services Kathleen Sibelius asking that she use her recently granted authority to at least temporary impose a “cooling off” period for new home health agencies in our states. Included in the letter was the following:
- ” CMS has sufficient data to indicate that rapid increases in the number of home health
agencies has led to increases in utilization and spending beyond that which would be
indicated by payment changes, growth in enrollees, or policy actions. The National
Association for Home Care and Hospice collected data indicating that from 2001-2006,
Medicare spending grew 2.5 times more in states where the number of home health
agencies (HHA’s) increased as compared to states where the number of providers
remained the same or decreased. - The proposed rules suggest that determining factors for moratoria include a trend of
growth that is disproportionate relative to the number of beneficiaries or a rapid uptick
in enrollment applications. The recent situation in Massachusetts satisfies both of those
requirements. After virtually no growth between 2001 and 2006, our state has seen an
increase of 27 certified agencies in the past four years – an increase of more than 20
percent. This has occurred despite the fact that no area of the state is un-served or
underserved. - This recent growth is driven by that fact that Massachusetts is one of only a few states
that has neither state licensure nor certificate of need rules for new home health care.
This ability to “take all comers” was further exacerbated by a CMS decision a few years
ago to allow state Survey agencies to transfer their responsibilities for new Medicare
home health certification to private accreditation agencies. Our experience is that these
private surveys are less rigorous and that it has become much too easy for new agencies
to become established without a full understanding of the complexity of Medicare
compliance. In fact, we believe that several agencies received Medicare deemed status
in the past five years have either been decertified or in danger of being decertified once
the state makes an initial survey. All of this adds costs and no value to our system.”
Our agenda also includes – thanks to one of our most responsive elected officials Congressman Jim McGovern – a meeting to try to bring some reasonableness to the federal/state “TPL” fight over paying for home care.
Please continue to share your thoughts on both our current industry challenges and what you see as needed fixes. When we are in DC, we are speaking for you.
More announcements in local press about members who have received the Alliance’s 
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