‘Full-Court Press’ Underway to Get Home Health Bills Passed

As home health providers are reeling in wake of new regulations, industry groups are stepping up their advocacy actions—and having some success. After a disastrous roll out of the Pre-Claim Review Demonstration from the Centers for Medicare & Medicaid Services (CMS) in Illinois, the agency announced it would delay implementation in the four other states, thanks in part to home health care providers and trade groups voicing their problems with the program.

With some success under its belt, a “full-court press” is on to push forward legislation in Washington, D.C., to better enable home health care businesses to provide care and meet compliance requirements. The National Association of Home Care & Hospice (NAHC) is one group heavily involved at the forefront of the press.

Earlier this summer, lawmakers introduced a bill that would make the Independence at Home program permanent. More than 100 industry groups support the measure, which would also expand the program by removing the limit on the number of beneficiaries that may participate.


The Independence at Home program enables Medicare beneficiaries who account for the top 5% of Medicare spending to receive primary care at home. Recent analysis from CMS reveals the program saved Medicare $10 million in its second year, and $25 million during its first year.

“It’s proven itself to be a very successful program from a patient outcome perspective and Medicare spending perspective,” William Dombi, vice president of law at the National Association for Home Care & Hospice (NAHC), told Home Health Care News. “From a home health agency perspective, it has a positive impact, but not significant. …It doesn’t open up the floodgates for home health, but it incentivizes the physicians to take a care management path that includes home health.”

A bill was introduced in July to make the program permanent and has strong bipartisan support, backed up by CMS’ recent analysis of its cost savings and improving patient outcomes.


“We not only think it should be permanent, but some form of Independence at Home should be put in place for the other 95% of Medicare beneficiaries,” Dombi said. “Independence at Home only focuses on the top 5% at-risk beneficiaries. That’s a top priority, but we believe a similar model, that may or may not need a physician involved, could be helpful, as well, to keeping the person healthy at home.

Care Planning Changes

Another bill that has been sitting in Congress is the Home Health Care Planning Act, which would enable other health professionals besides physicians to sign off and approve home health care services.

The bill has the potential to greatly streamline services and relieve some of the pressure home health care agencies currently face. Current regulations mandate that only physicians are allowed to order home health services.

The bill would open up that ability to physician assistants (PA), nurse practitioners (NP), clinical nurse practitioners (CNP) and certified nurse midwives. While these health care professionals are allowed to perform home health care services for Medicare beneficiaries, the regulations that prohibit them from ordering the services cause a headache for home health agencies looking to provide care.

“We believe that it would be improving so many elements in home health delivery,” Dombi said of the bill. “It’s not logical to have the health care system shifting more and more away from physicians, but still leaving the Medicare certification power in the hands of the M.D. Nurse practitioners may care for a patient for years, and now they have to turn to a physician for certification who may not even know the patient.”

Mandates that only primary care physicians can order home health services have contributed to inefficiencies across the health care system, as agencies have found it difficult to get timely signatures. This process has been particularly burdensome within the pre-claim process.

“To have that M.D. involved creates a breakdown in collaboration and communication, and that could impact patients along the way,” Dombi warned. “The bill allows a substitution of what the M.D. is doing. In doing so, it makes care much more direct. From a spending perspective, it also allows Medicare to spend less to get the certification from a nurse practitioner than from an M.D. The clinical value comes from the person who has direct patient care contact.”

While the bill would undoubtedly streamline home health care certification for agencies, there is little hope it would improve the Pre-Claim Review Demonstration currently underway in Illinois. Instead of enabling other health care professionals to certify home health claims, the entire claims process needs a better solution than pre-claim, Dombi explained.

“The solution we are still believing in is not about who created the [claims] record, but the whole [claims] review,” Dombi said.

Written by Amy Baxter

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