Changes to Medicare Home Health Care Coverage

Table of Content

• Home Care and Individualized Education Plans (IEP)
• Home Health Care Medicare Requirements
• Coordination with other MA services
• Changes in Medicare Home Health Use During COVID-19 and the Implications for Health Equity and Caregiver Availability
• Home Health Patient Rights
• Medicare Benefits Review Registration Center
• How Long Does Medicare Pay For Home Health Care
• Home Health Care Use Increased in Medicare Advantage Relative to traditional Medicare between 2011 and 2016

Treatment codes may be inconsistently applied, in part, because home health care services are ill-defined. Further, the growing volume and intensity of home health care necessitates an evaluation of current medical review processes, including a reexamination of how cases are selected for review and a consideration of giving HHAs greater responsibility for utilization review. A home health episode was defined based on claims for 30-day episodes in the 2020 data. Analogous 30-day episodes were constructed for the 2019 home health episode claims to allow for comparison of claim counts across years, following the change from 60-day to 30-day home health episodes with the introduction of the Patient-Driven Groupings Model in 2020. In both 2011 and 2016, Medicare Advantage home health spells were shorter than traditional Medicare home health spells by 6.7 and 7.3 days, respectively after adjustment for beneficiary characteristics including primary diagnosis and functional status .

When the targeted genomic sequence analysis panel for a solid organ neoplasm involves only RNA analysis, use new code 81449; and when the targeted genomic sequence analysis panel for hematolymphoid neoplasms or disorder includes only RNA analysis, use new code 81451. Code describes the replacement including the removal of the implant with magnetic transcutaneous attachment to an external speech processor outside of the mastoid that results in the removal of greater than or equal to 100 sq mm surface area of bone. Code describes the implantation of the osseointegrated implant with magnetic transcutaneous attachment to an external speech processor outside of the mastoid that results in the removal of greater than or equal to 100 sq mm surface area of bone. Code describes the removal of the osseointegrated implant with magnetic transcutaneous attachment to an external speech processor outside of the mastoid that results in the removal of greater than or equal to 100 sq mm surface area of bone. Code +33904 reports each additional vessel or separate lesion in normal or abnormal connections. A new code for the repair of a nasal valve collapse, 30469, is added to report the use of low-energy, temperature-controlled subcutaneous/submucosal remodeling.

Home Care and Individualized Education Plans (IEP)

Before your care starts, your Medicare-certified home health agency should present you with a breakdown of the charges and what Medicare will pay. This notice should also include how much youll be required to pay out of pocket. Homemaking services if you dont also require skilled medical care or therapy. If youâre a resident of one of these states, you might want to request a pre-claim review as soon as your doctor orders your home health care.

Doctors can advocate for their patients and fight to get the necessary help. Further, he/she can’t be of assistance if they don’t know what’s going on. Support for initiatives aimed at reducing racial differences in hospitalization rates during home health episodes. Consistent with overall trends in health care utilization during the COVID-19 pandemic, the number of Medicare beneficiaries using home health care decreased by 6 percent in 2020 compared to 2019. However, the gender and racial composition of home health users remained similar across both years .

Home Health Care Medicare Requirements

It may be possible to extend that duration of coverage under special circumstances. Providers must be familiar with Medicare coverage for home care members. Bill Medicare when Medicare is liable for the service or, if not Medicare certified, refer the member to a Medicare-certified provider of the member’s choice. Notify members when Medicare is no longer the liable payer for home care services.

Total hours of service allowed for home care nursing and personal care assistance services provided in a school setting as IEP services cannot exceed that which is otherwise allowed in the community or in-home setting. Services requiring the start of service face-to-face visit include skilled nurse visits, home health aide visits and home care therapies. Home care therapies are occupational, physical, respiratory and speech languages therapies.

Coordination with other MA services

The Home Health or Home Care Nurse Care Plan is a written description of the home care services the member needs as assessed to maintain or restore optimal health. There may be additional noncovered services outlined under each provider-type specific covered service page. Once your doctor refers you for home health services, the home health agency will schedule an appointment and come to your home to talk to you about your needs and ask you some questions about your health.

This proposed rule contains the first refinements to the Medicare home health prospective payment system since 2000 and also contains the annual update to the Medicare HH PPS payment rates. The shifts in nursing and therapy visits during the pandemic reflects the relative change in severity of illness for both groups of beneficiaries. The decrease in nursing and physical therapy home visits was smaller among beneficiaries admitted from hospitals and postacute facilities, possibly because of the increase in severity of illness experienced by this group during this period. The small increase (1.4%) in the proportion of home health episodes following an acute or postacute care discharge is also notable.

Changes in Medicare Home Health Use During COVID-19 and the Implications for Health Equity and Caregiver Availability

Though a relatively small change, this finding indicates a shift in home health use among this subpopulation during the pandemic. To decrease Medicare spending, the Medicare Payment Advisory Commission recommended a 5% reduction in payments to home health agencies for 2020. A Medicare-certified home health agency must deliver care or it will not be covered. To find a reputable agency in your area, Medicare offers a searchable database at Home Health Compare. Short, infrequent absences for nonmedical reasons (e.g., attending a family event) should not count against you either.

Codes for percutaneous nephrolithotomy or pyelolithotomy are revised to clarify which services are included when performing the procedure, so they can be properly valued. Code is reported for a simple procedure that involves stones up to 2.0 cm. Stones greater than 2.0 cm, branching stones, stones in multiple locations, ureter stones, and anatomical complications are considered complex and reported with 50081. CPT® 2023 includes five new codes for percutaneous pulmonary artery revascularization by stent placement. For more information on your privacy rights as a home health patient, read the Home Health Agency OASIS Statement of Patients Privacy Rights.

Home Health Patient Rights

Between 2011 and 2016, average home health spell lengths fell across all Medicare Advantage plan types except HMOs . Spell lengths fell 3.5 days more in PPO than in HMO plans during this period, though PPO spells were still longer than HMO spells in 2016. Community-admitted home health spell lengths fell for all Medicare Advantage plan types between 2011 and 2016, with these spells decreasing 5.9 days more in PPOs than in HMOs over this period. However, PPO home health spells remained longer than HMO home health spells in 2016. In 2015, 12,346 home health agencies served 3.5 million Medicare enrollees, and these services accounted for approximately 5 percent of traditional Medicare spending.

Be given a copy of your plan of care, and participate in decisions about your care. Find a plan that fits your budget and covers your doctor and prescription medications now. While this mainly applies to bigger cities, if you are dissatisfied with the answers you’re getting from your current agency, research others. Many agencies are just as, if not more, qualified than your current home health provider. The Assistant Secretary for Planning and Evaluation is the principal advisor to the Secretary of the U.S. Department of Health and Human Services on policy development, and is responsible for major activities in policy coordination, legislation development, strategic planning, policy research, evaluation, and economic analysis.

Caregiver assistance was lower among Black and Asian American beneficiaries, regardless of the care setting from which they were admitted. During the COVID-19 pandemic, nurse practitioners, clinical nurse specialists, and physician assistants can provide home health services, without the certification of a physician. It does not include meal deliveries to the home, custodial care (e.g., help with dressing, feeding, or toileting), or homemaker services (e.g., help with cleaning, laundry, or shopping).

However, the Medicare Payment Advisory Commission has expressed concern about growth in admissions to home health directly from the community, suggesting these admissions may be substituting for long-term care benefits that are not covered by the Medicare program. The new value-based model disrupts how home health care is reimbursed. Still, questions remain if it will financially incentivize home health agencies to change the types of services it offers or limit services for some Medicare beneficiaries. Reach out to your healthcare provider if you think you could benefit from home health care. Changes in medical status are either temporary for 45 days or less or long term for up to 365 days .