Home Health Providers Failing to Deliver Required Services, New Survey Suggests

Medicare-certified home health providers are falling short when it comes to the amount of care services they’re offering, a new survey released Thursday from the Center For Medicare Advocacy (CMA) suggests.

“Our surveys confirmed what we, unfortunately, hear all the time at [CMA], either directly from the beneficiaries, family members or friends who’ve tried to get services ordered by an authorized practitioner and cannot,” Judith Stein, founder and executive director of CMA, told Home Health Care News. “Some services are cut entirely – or in part – during the course of an episode. Access is a huge problem.”

CMA is a Washington, D.C.-based nonprofit law organization that is focused on health equity and improving access to comprehensive Medicare coverage.

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As part of the survey, CMA gathered responses from 217 Medicare-certified home health agencies in 20 states to find out what beneficiaries likely experience when trying to access home-based care.

To gather this information, CMA inquired about available services from each agency for a hypothetical patient with an authorized practitioner’s order certifying one hour of physical therapy weekly, one hour of skilled nursing weekly and 20 hours of home health aide services weekly.

All of the agencies stated they could provide one hour of physical therapy weekly, and 99% said they could provide one hour of skilled nursing care weekly. However, responses began to falter when agencies were asked about access to home health aide services.

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Specifically, 15% of agencies did not provide a clear answer about availability. The majority of agencies that did answer could not offer the amount of aide services that satisfied the benefit as defined by Medicare law, according to CMA.

Though Medicare law authorizes 28, or more, hours weekly for beneficiaries that meet the criteria, only 4% of agencies said they would be able to deliver 20 hours of home health aide services weekly. About 95% of agencies were able to deliver six hours or less weekly.

CMA also found that agencies had a misunderstanding of Medicare coverage law. In fact, 20% of agencies from 17 states cited incorrect information about Medicare coverage as a response when they weren’t able to deliver the amount of hours or types of home health aide services required.

More than 20% of agencies stated incorrectly that “bathing and grooming” are the only services provided by home health aides.

“There’s a list of some 15-plus services that home health aides can provide under Medicare coverage, and bathing is only the first of those many services,” Stein said. “It’s hands-on personal care and defined, quite particularly, in the federal regulation. [Agencies] should look at that. People are way too often told that only a bath is available, or all sorts of other things that simply aren’t true.”

Plus, agencies had a tendency to incorrectly state that improvement is required for Medicare home health coverage. Roughly 33% of agencies answered “no” to the question, “Does your agency offer Medicare-covered services to maintain a person’s condition or prevent their decline?”

While the COVID-19 emergency has, no doubt contributed to staffing shortages at agencies, Stein points out the issues highlighted in the survey began several years ago.

“Recognizing that there are currently staffing problems, nonetheless, for years way before COVID-19, we’ve been hearing inaccurate understandings of what Medicare coverage is for home health,” she said.

In order to improve access to care, Stein urges agencies to familiarize themselves with Medicare law and what they should be offering.

“I hope they will take another look at what Medicare really should be covering for beneficiaries in terms of the skilled services, nursing and the therapies, but, particularly, also familiarize themselves with two main things,” she said. “One is the personal care coverages available, or to be provided by home health aides. … The second major thing is for providers to learn and incorporate in their practices that improvement is not required for Medicare to cover home health services.”

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