Congress Considering Co-Pay for Medicare Skilled Care Visits for Seniors

Medicare does not pay for long-term nursing home care and also does not pay for caregiving services in the home.  However, Medicare does pay for skilled care visits in the home which are usually a temporary service to assist a senior in recovering from a stroke, hip replacement surgery or another medical condition which can improve with visits from a R.N., Speech Therapist, Occupational Therapist, Physical Therapist and sometimes a Certified Nursing Aide (C.N.A. visits contribute to only about 5% of Medicare skilled care visits - this is because seniors must privately pay for caregiving services).

A Congressional commission has suggested a new co-pay for Medicare home care visits, mostly as a way to combat abuses that have been taking place in the system.  What better way to keep home health agencies accountable than to ask seniors to chip in for the cost of the service, right?

It definitely is somewhat unfortunate that this is the only way the government can combat abuse and fraud but since Medicare fraud has been to the tune of $6 billion, it also definitely is a positive move that the government is trying to make some changes in the Medicare payment system for home health care.

The lobbying effort has begun and this is a battle the home health industry has fought and won before.

The Medicare Payment Advisory Commission, known as MedPAC and established by Congress to advise members on Medicare payments and finances, voted 13-1 Wednesday to recommend the government health care program charge certain beneficiaries for 60-day “episodes” of home health treatment. The illustrated co-pay would total $150 per episode of care.

MedPAC analysis found Medicare spent $19 million in home health expenditures in 2009, paying for 6 million episodes of care among 3 million beneficiaries. The report highlighted growth in the industry, with over 3,800 new agencies established since 2000, and underscored unusually high usage in Texas, Florida's Miami-Dade County, and Louisiana.

The timing of the co-pay recommendation, which is expected to be a cost-saver, could lead to its inclusion in the president's budget, expected in February.

But lobbyists for the home health industry argue the government should not establish a co-payment for all beneficiaries, but instead focus an effort on specific counties and providers that are using home health services at two to three times the national average.

“A policy like this is akin to using a blunt instrument instead of a laser-like approach,” said one industry lobbyist. One industry suggestion would establish a moratorium on new home health agencies to target providers who defraud the system, as opposed to beneficiaries who may overuse the benefit. The healthcare overhaul law gives the federal government power to establish such a moratorium.

Home health associations also maintain that the co-pay will provide incentive for beneficiaries to go to the hospital, which is more costly for the Medicare program, instead of receiving cheaper home health care.

This is not the first time a potential co-pay for Medicare home health services has made its way through Capitol Hill: A cost-saving provision was on the negotiating table during the 2003 debate over the Medicare Part-D bill. Although the provision had a strong supporter in then-Ways and Means Chairman Bill Thomas, R-Calif., in-party opposition from Republicans, including Sen. Susan Collins of Maine, stripped the provision from the final bill. With a new Republican majority in the House, history may bode well for those working to keep home health services free of co-pays.

However, this time around the Republicans have been campaigning for cost-savings for the budget, saying they want to reduce the deficit.  As this is an area where there seems to be some misuse of a benefit, along with the 13-1 commission recommendation, the co-pay provision could pass.

Caregiverlist provides the daily costs of nursing homes and the benefits provided for home care by Medicare.



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