House Lawmakers Reintroduce Independence at Home Demonstration Act

A bipartisan group of House lawmakers took the first swing at extending the Independence at Home Medical Practice Demonstration Program last week, reintroducing H.R. 3644 on July 9. 

The bill was reintroduced in the House by Reps. Michael C. Burgess (R-Texas), Debbie Dingell (D-Mich.), Kenny Marchant (R-Texas) and Mike Thompson (D-Calif.).

“The Independence at Home program is a fiscally-responsible solution to help seniors access quality health care and expand the capacity of our nation’s health care system,” Rep. Burgess, a physician by trade, said in a statement. “Under this program, high-needs patients continue to receive individual care in the comfort of their homes, reducing unnecessary hospitalizations and allowing physicians and primary care teams to spend more time with patients.”

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In general, the introduction of H.R. 3644 — the Independence at Home Demonstration Act of 2019 — is yet another example of the broader push for health care services toward the home, especially as decisionmakers look to lower U.S. health care spending.

“This is an important program for the homebound frail and elderly in this country,” Bob Sowislo, co-chair of the American Academy of Home Care Medicine (AAHCM) public policy committee, told Home Health Care News. “This is one of the more successful chronic care programs that’s ever been introduced by CMS.”

Chicago-based AAHCM is an organization set up to advance home-based medical care. Its members include a variety of health care providers that bring care to the home, including home care physicians, medical directors of managed care plans and nurse practitioners.

If passed, H.R. 3644 would extend the Independence at Home Medical Practice Demonstration Program for three years.

Eligible beneficiaries would be able to continue receiving individual care in their homes, which lawmakers believe will reduce unnecessary hospitalizations and allow physicians and primary care teams to spend more time with patients.

In April, a similar bill (S. 1202) was introduced into the Senate. One of the key differences between the S.1202 and H.R. 3644, however, is the Senate bill pushes for the program to be made permanent. 

One of the leading supporters of the program becoming permanent is AAHCM.

“While there have been tens of thousands taken care of, there are well over 1 million Medicare patients who are home- and bed-bound, and could be taken care of under this program,” Sowislo said. “One of the big drawbacks of the program is that its only been limited to 15 demonstrations and practices nationally.”

IAH is a demonstration project started by the Center for Medicare & Medicaid Innovation (CMMI) in 2010, allowing Medicare beneficiaries who have multiple chronic conditions to receive primary care services at home. In the first few years of its existence, the program had a cap of 10,000 beneficiaries.

In 2018, The IAH program was extended for another two years with Congress, increasing the cap on participating beneficiaries from 10,000 to 15,000.

Historically, the program has been a success, with savings found to be 10 times as high as those achieved by accountable care organizations (ACOs) in its first two years, according to research published in the Journal of the American Geriatrics Society.

In fact, in the first two years of the demonstration, IAH sites cared for more than 10,000 patients with savings totaling more than $35 million.

“Dallas is home to one of the 12 practices participating in the Independence at Home Demonstration, with the program’s patients in our district already saving an average of $160 a month while receiving the home-based care they need,” Rep. Marchant said in a statement.

Additionally, experts believe that the bill will have a positive impact on home health providers.

“One of the hallmarks of the program is that its a team-based model,” Sowislo said. “In order to do a good job not only do the demo practices need to be able to bring team-based care into the home, but they also have to work with the community. A hallmark of the community is home health agencies, who need this kind of team-based care to provide quality services to their patients.”

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