Statement of the National Association for Home Care & Hospice on the Lawsuit Filed Challenging Medicare Policies and Practices within the Home Health Benefit
October 11, 2022| FOR IMMEDIATE RELEASE |
Statement of the National Association for Home Care & Hospice on the Lawsuit Filed Challenging Medicare Policies and Practices within the Home Health Benefit
Washington, D.C. – Please note: NAHC President William A. Dombi will be available for a follow-up interview if you have any additional questions regarding the case and/or the NAHC statement. Please respond to this email to set up an interview. The following statement refers to a class action lawsuit against the Secretary of the U.S. Department of Health and Human Services (HHS), accusing the federal agency of failing to properly administer the Medicare home health benefit. NAHC is not a party to the lawsuit. This statement may be attributed to Mr. Dombi.
“Decades of misguided policy changes in the Medicare home health benefit have eroded rights guaranteed in Medicare law to over 60 million beneficiaries. While the home health benefit includes 28-35 hours a week of medically necessary home health aide services, policy changes, arbitrary audit practices by Medicare contractors, and an endless series of payment rate cuts have made those rights a mere fiction.
“In the past two decades alone, payment policies have effectively re-written the home health benefit. The current 30-day episode base payment rate recognizes the cost of less than a single visit of a home health aide, rendering it impossible for any provider to offer 28-35 hours a week of aide services. “You cannot realistically expect a home health agency to be able to deliver 28-35 hours a week of aide services with an effective $80 of reimbursement. Even with outlier payment, Medicare’s own analysis shows a $5000 shortfall in payment to the provider.
“CMS is now on a path to further dismantle the home health benefit with a proposed 7.69% rate cut that would take effect on January 1. With the final rule expected this month, we hope that CMS recognizes the disaster in the making such a cut would trigger. We have asked the Administration to suspend that cut in hopes of getting CMS to re-evaluate its proposal.
“The lawsuit, Johnson v. Becerra, 22-cv-3024, was filed in the U.S. District Court for the District of Columbia on October 6, 2022. In 1987, NAHC, a class of Medicare beneficiaries and home health agencies, along with 13 Members of Congress sued Medicare on its home health policy and claims audit practices, leading to the establishment of the 28–35-hour aide services scope of benefits. However, in the succeeding years, numerous changes in policies and practice combined with payment rate cuts have completely changed the practical scope of home health benefits. While all measures show the quality of home health remains high, the full promise and value of the benefit is yet to be realized.”
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About National Association for Home Care & Hospice (NAHC)
The National Association for Home Care & Hospice (NAHC) is the voice of home care and hospice. NAHC represents the nation’s 33,000 home care and hospice providers, along with the more than two million nurses, therapists, and aides they employ. These caregivers provide vital services to Americans who are aged, disabled, and ill. Some 12 million patients depend on home care and hospice providers, who depend on NAHC for the best in advocacy, education, and information. NAHC is a nonprofit organization that helps its members maintain the highest standards of care. To learn more, visit nahc.org.