The Medicare Payment Advisory Commission (MedPAC) once again is asking Congress to impose a home health copay for certain episodes and remove therapy visit counts as a payment factor. Experts believe the copay recommendation in particular could take on added significance as Congress continues to search for cost savings in the Medicare program.
 
The recommendations came as part of MedPAC’s annual report to Congress, which is published every March. The current set of recommendations for home health were first issued in the 2011 report, and reprinted in the 2012 report.
 
In this year’s report, MedPAC also decided to weigh in on the recent settlement to end the “improvement standard” in Medicare. Until CMS revises its benefit manuals and educates providers on those revisions, it’s hard to say what the case will mean for home health utilization, MedPAC argues. “However, given the rapid growth the benefit has experienced in the past, it remains possible that utilization could increase.”
 
For hospice, MedPAC has one new recommendation: Eliminate the payment update for fiscal 2014. The commission’s rationale: “Payment indicators for hospice are generally positive.” Both the number of hospices in the market and the number of beneficiaries enrolled in hospice are on the rise, MedPAC says.
 
The commission also chose to reprint its recommendation to reform hospice payments according to a “U-shaped” model, meaning payments would be higher on admission and just before the patient’s death.
 
Here is a rundown of MedPAC’s home health recommendations:
  • Establish a copay for episodes not preceded by a hospitalization or post-acute stay. As in previous years, MedPAC offers the example of a $150 per-episode copay.
  • Begin a two-year rebasing of home health rates in 2013.
  • Revise the case-mix system to remove the number of therapy visits as a payment factor.
  • Implement enrollment moratoria and targeted medical review in areas with “aberrant” utilization.