Why Political Roadblocks Threaten Home Health Care’s Biggest Policy Objectives in 2022

Policy concerns in home-based care are considered timely and critical for those in the industry. The issue is, unfortunately, they aren’t always viewed in that light by outsiders and lawmakers in Washington, D.C.

Among those concerns are the extension of the Acute Hospital Care at Home waiver, adequate reimbursement for telehealth and the Choose Home Care Act.

“There is a level of gridlock and partisanship in Washington, D.C., that’s created a limited number of opportunities, which is disappointing,” William A. Dombi, president of the National Association for Home Care & Hospice (NAHC), said during a Home Care 100 panel discussion earlier this month. “But I think we are extraordinarily well positioned. And maybe in March, there will be opportunities for further legislation.”


Choose Home is still awaiting a score from the Congressional Budget Office (CBO), which similarly, has a lot on its plate. If Choose Home’s passage were put to Vegas odds, Dombi said that advocates are certainly “not playing with house money.” He did, though, give it an “even” chance of passing this year – meaning about 50%.

As for hospital-at-home legislation that would extend the Acute Hospital Care at Home waiver – which is tied to the public health emergency (PHE) – Dombi and others are more bullish.

A handful of senators have already drafted legislation to extend it, according to Alison Armstrong, the executive director of Moving Health Home.


The Washington, D.C.-based Moving Health Home is an advocacy organization that vies for favorable legislation for home-focused health care providers.

“Legislative language is already drafted,” Armstrong said during the panel discussion. “What we’re hearing is that there’s widespread, bipartisan support. The biggest pushback we’re hearing from the Hill offices has to do more with the data coming out of the program, which they view as limited.”

More time will bring more data, which is part of the reason why advocates believe the waiver should be extended.

Telehealth reimbursement

Home health care providers have been granted more flexibilities relating to telehealth during the PHE, but are still not fully paid for their remote visits.

It has been advocated for on a non-stop basis over the last two years, and yet there hasn’t been much tangible progress. And there’s a reason for that.

“From a Medicare home health perspective, you’ve got a roadblock,” Dombi said. “The statute itself prohibits payment for telehealth services within the payment model.”

In order to turn the corner on telehealth reimbursement for home health, the only feasible route advocates can take is through Congress. From there, a demo program would have to be created by the Center for Medicare & Medicaid Innovation (CMMI).

Another potential roadblock, however, is that telehealth has been abused during the pandemic. Not necessarily by home health providers – it would be hard to abuse it without corresponding pay – but instead by other health care providers across the continuum.

“The caution light is going off in Washington relative to telehealth services, and we’re the fall guys,” Dombi said, referring to the home health care sector.

Furthermore, because home health and hospice agencies delivered a significant amount of telehealth services during the pandemic for free, the expectation out of Washington, D.C., is that they’ll always be willing to do so.

Dombi mentioned that he believed reimbursement would eventually be provided for telehealth in home health, but that it won’t be as easy as NAHC once thought it may be at the beginning of the PHE.

HHVBP concerns

Home health providers have the year ahead to gear up for the 2023 expansion of the Home Health Value-Based Purchasing (HHVBP) Model.

For the most part, the reaction to that news has been positive.

There are dissenters, though. Specifically, there are providers that believe the line being drawn between “winners” and “losers” in HHVBP is too binary. For instance, a small difference in level of performance could separate the 45th-percentile and 55th-percentile agencies.

The president and CEO of Visiting Nurse Association Health Group, Dr. Steve Landers, is also in favor of the expansion of HHVBP, but does think some questions are warranted for value-based care programs in general.

“I think having the payment model be reflective of outcomes is a good evolution,” Landers also said on the panel. “It intends to incentivize excellence. And that’s we want to be doing as teams and also as an industry.”

The nine-state demonstration program of HHVBP saved $600 million, Landers mentioned. That is a testament to the industry’s work, but also makes one wonder where the savings are going, he said.

“Now, I’m still waiting to find out when we get any of that $600 million,” Landers said. “And then when it’s expanded, there’s going to be billions more that we’re going to save. I want to know when the savings check is coming … so that we can provide more services, make sure we have the best technology and that we’ve got the right investments in workflow.”

Landers continued with measured concerns of the program.

His next point was one others have brought up since the expansion announcement: the question of whether the model would have an adverse effect on the most vulnerable populations.

“We have to watch out, as we get into like things like value-based purchasing, that we don’t put in place ground rules that make it hard for different provider types to embrace taking care of very sick people,” Landers said. “When President [Lyndon] Johnson signed the Medicare law, he said that it’s about never ignoring untended suffering in a land bursting with abundance.”

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