In October 2016, the Centers for Medicare and Medicaid Services, or CMS, announced that they would be reducing payments for home healthcare by .7%, in addition to other changes.
As new healthcare legislation looms and national debates erupt over how the United States handles its healthcare system, one thing is certain: seniors and their caregivers will experience changes in Medicare legislation and reimbursement. Already in 2017, the Centers for Medicare and Medicaid Services, or CMS, announced that they would be reducing payments for home healthcare by .7%, in addition to other changes. (It may sound small, but the budget for such changes is so large that this small change reduces payments by $130 million, according to the Home Care Association of New Hampshire.) But how is this reduction being completed, and what might that mean for home healthcare services and workers?
Home Healthcare Services
For those who may not know, in-home healthcare services are agencies which provide care for seniors in their homes. Especially if seniors decide to age in place or are recovering from medical procedures, in-home healthcare aides allow them to stay home and still receive caregiving services, rather than requiring them to move into a care facility such as a nursing home or assisted living facility. These agencies help seniors with activities of daily living, physical therapy, medication regimens, wound care, and much more. Medicare will reimbursed qualified in-home care costs for seniors who need it. This is a worthwhile investment, especially for low-income seniors who cannot afford or would suffer as a result of facility living.
The first and most direct way that this reduction occurs is a direct payment reduction. Home healthcare services will now be reimbursed less for their work. Some seniors may be able to compensate for this reduction in reimbursement through secondary insurance, which typically will take up most or all of the remaining cost. If a senior does not have secondary insurance or if their secondary insurance provider does not cover the entire remaining cost, seniors must pay out-of-pocket for in-home healthcare services.
This could have very little effect, requiring some clients to pay more out of their pockets or charge more to a secondary insurance agency, depending on the senior in question. It could, however, be catastrophic for low-income seniors. Those who cannot pay out-of-pocket will have to rely on care from family members or move into a facility—if they can afford such a move—in order to maintain their health and safety. For rural and low-income seniors, these moves and a dependency upon relatives (who are also likely rural and/or low-income) for care could mean less care or even no care at all. This places their health and safety at risk.
In addition to affecting senior health and safety, agencies that get paid less and lose clients can expect to lay off workers or even close their doors. Although the hope is that this reduction can be displaced across all such services, resulting in some discomfort but the overall absorption of the cost, some in-home health care agencies will experience almost no changes and others could face the worst kinds of changes. Especially as more of the United States population reaches retirement age and requires in-home healthcare, reducing the number of employed and trained in-home health aides is a problem. There are already shortages across the country of caregivers for seniors, and many family caregivers provide more services than they truly can or should; closing the doors of existing agencies could only exacerbate the problem.
What You Can Do
As always, you should work to educate yourself and those around you when it comes to legislation affecting Medicare, Medicaid, and healthcare legislation. Low-income seniors are at risk, like many low-income people, of losing access to important healthcare services due to their cost. Being a knowledgeable consumer and voter goes a long way toward protecting the access seniors have to high-quality, life-saving care.
If you are an in-home healthcare service provider, talk with your fellow caregivers, seniors, and their families about payment structures, what they can afford, and how they can afford it. Working with your bosses on how the money is made and charged to clients properly in order to get maximum Medicare benefits for them can help continue their use of your services, keep your job, and keep seniors healthy.
If you are a non-professional or family caregiver, consider looking into in-home health care services near you. Supporting qualified professionals and agencies can help keep the doors open and give your loved one an opportunity to experience even better care. It also gives you a way to relax and attend to your own needs, even if you provide the bulk of care for your loved one. This can be especially helpful if you need to travel, become sick yourself, or require respite from the stress and labor of caregiving. Do your research and support local caregivers as they work to provide the best, safest, healthiest lives for seniors.
Centers for Medicare & Medicaid Services (CMS). Home Health Agency (HHA) Center. Available at https://www.cms.gov/Center/Provider-Type/Home-Health-Agency-HHA-Center.html. Retrieved May 4, 2017.
Federal Register. Medicare and Medicaid Programs; CY 2017 Home Health Prospective Payment System Rate Update; Home Health Value-Based Purchasing Model; and Home Health Quality Reporting Requirements. FederalRegister.com, July 5, 2016. Available at https://www.federalregister.gov/documents/2016/07/05/2016-15448/medicare-and-medicaid-programs-cy-2017-home-health-prospective-payment-system-rate-update-home. Retrieved May 4, 2017.
Home Care Association of New Hampshire. CMS Publishes Final Rule for 2017 Medicare Home Health Rates. HomeCareNH.org, November 1, 2016. Available at http://homecarenh.org/wp-content/uploads/2016/11/14478/. Retrieved May 4, 2017.
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