The U.S. District Court for the District of Columbia has dismissed a class action lawsuit that accused the U.S. Department of Health and Human Services (HHS) of failing to properly administer the Medicare home health benefit.
The plaintiffs had argued the home health services required under Medicare law were wholly insufficient.
Medicare law authorizes coverage for up to 35 hours per week of home health aide services for personal, hands-on care. In some instances, the plaintiffs claimed they had received minimal services or none at all.
In the dismissal, federal judges found that the patients’ complaint didn’t identify what HHS could have done to ensure adequate home health services were delivered to them.
In a statement sent to Home Health Care News following the dismissal, William A. Dombi — the president of the National Association for Home Care & Hospice (NAHC) — said that aide services have been a significantly declining part of home health services provided to Medicare patients since the 1990s.
“The lawsuit sought to change that in seeking a ruling requiring Medicare to increase oversight of home health agency operations,” Dombi said. “The federal court dismissed the case based on its finding that it was only speculative that the relief sought by the Medicare beneficiaries could redress the alleged harm.”
Some of the same concerns in the lawsuit were initially brought up when the Choose Home Act started to gain traction. That piece of legislation — which would provide an add-on to the home health benefit as an alternative to skilled nursing facility stays — has stalled in D.C.
The Center for Medicare Advocacy initially sued HHS on behalf of itself, the National Multiple Sclerosis Society and three individuals with personal stories on how they had been inadequately cared for and — in some cases — lied to about what Medicare converge they were eligible for.
Ultimately, the court threw out the case and wrote that home health agencies make “independent business” decisions for a wide variety of reasons as to why they accept patients into care and what services they make available to potential patients.
“Importantly, the court also recognized that the Medicare payment system, payment rates and labor market ‘surely play into an HHAs’ calculus on whether to offer aide services,’” Dombi pointed out. “NAHC has long argued that changes in Medicare payment by both Congress and CMS has led to a deterioration in the home health services available. The increased oversight sought through the lawsuit would not change that central weakness in the Medicare benefit.”