Module 1, Topic 1
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Day 1: Home Health Benefit

Petria September 3, 2020
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What is Medicare Home Health?

The Medicare home health benefit is a crucial source of health care financing for Medicare beneficiaries who reside in their homes and need medical attention.

Medicare’s history: Key Political takeaways

  • President Harry S Truman called for the creation of a national health insurance fund in 1945.
  • President Lyndon B. Johnson signed Medicare Act into law in 1965.
  • 1966 Medicare was implemented and more than 19 million individuals enrolled by July 1.
  • 1980 Omnibus Reconciliation Act
  • 1982 – The National Home Care Association was established
  • 1990 Saw an expansion of agencies
  • 1997 Balanced Budget Act (BBA)
    • IPS 1998
    • PPS 2000
    • OASIS created
  • In 2019, 60.6 million Americans received coverage through Medicare
  • 2020 PDGM
  • Medicare spending is expected to account for 18% of total federal spending by 2028.

Medicare Benefits

  • Pays for skilled nursing care, physical therapy, occupational therapy, speech therapy, medical social work, home health aide services, medical supplies.
  • Limits services through program participation requirements.
  • Focuses primarily on short term care and post acute, post hospitalization care.
  • A physician must make the referral for home health care to a home health care agency and oversee the plan of care.
  • Patients must be temporarily or permanently homebound.
  • Patients must have a need for skilled services

What’s home health care?

Home health care is a wide range of health care services that can be given in your home for an illness or injury. Home health care is usually less expensive, more convenient, and just as effective as care you get in a hospital or skilled nursing facility (SNF).

Examples of skilled home health services include:

  • Wound care for pressure sores or a surgical wound
  • Patient and caregiver education
  • Intravenous or nutrition therapy
  • Injections
  • Monitoring serious illness and unstable health status

In general, the goal of home health care is to treat an illness or injury. Home health care helps you:

  • Get better
  • Regain your independence
  • Become as self-sufficient as possible
  • Maintain your current condition or level of function
  • Slow decline

What should I expect from my home health care?

  • Doctor’s orders are needed to start care. 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.
  • The home health agency staff will also talk to your doctor about your care and keep your doctor updated about your progress.
  • It’s important that home health staff see you as often as the doctor ordered.

Examples of what the home health staff should do:

  • Check what you’re eating and drinking.
  • Check your blood pressure, temperature, heart rate, and breathing.
  • Check that you’re taking your prescription and other drugs and any treatments correctly.
  • Ask if you’re having pain.
  • Check your safety in the home.
  • Teach you about your care so you can take care of yourself.
  • Coordinate your care. This means they must communicate regularly with you, your doctor, and anyone else who gives you care.

Qualifications of Home Health Care

Medicare Part A

  • Pays for home health care if patients meet the two requirements
  • Homebound
  • Need for skilled service
  • Patients do not pay additional costs or co-payments.
  • Patients must have a referral from a physician who certifies home health care as medically necessary.
  • Pays for 60-day episodes; as of January 2020 but 2 separate 30 day periods

Medicare does not pay for:

  • 24-hour-a-day care at home
  • Meals delivered to your home
  • Homemaker services (like shopping, cleaning, and laundry), when this is the only care you need
  • Custodial or personal care (like bathing, dressing, or using the bathroom), when this is the only care you need

MedPAC

The Medicare Payment Advisory Commission (MedPAC) is an independent congressional agency established by the Balanced Budget Act of 1997 to advise the U.S. Congress on issues affecting the Medicare program. The Commission’s statutory mandate is quite broad: In addition to advising the Congress on payments to private health plans participating in Medicare and providers in Medicare’s traditional fee-for-service program, MedPAC is also tasked with analyzing access to care, quality of care, and other issues affecting Medicare.

The Commission’s 17 members bring diverse expertise in the financing and delivery of health care services. Commissioners are appointed to three-year terms (subject to renewal) by the Comptroller General and serve part time. Appointments are staggered; the terms of five or six Commissioners expire each year.

MedPAC meets publicly to discuss policy issues and formulate its recommendations to the Congress. In the course of these meetings, Commissioners consider the results of staff research, presentations by policy experts, and comments from interested parties.

Two reports—issued in March and June each year—are the primary outlet for Commission recommendations. Visit MedPAC.gov for more information.