Bipartisan Medicare Home Health Benefit Bill Has Nursing Homes Upset

By Maya Goldman / August 2, 2021

Medicare beneficiaries could receive post-acute care, including daily living support, at home under a new bill introduced Thursday (July 29) by Sens. Debbie Stabenow (D-MI) and Todd Young (R-IN). Home health care advocates hope the bill moves through Congress this year, but the nursing home lobby strongly opposes the measure and at least one Medicare beneficiary advocacy group worries the lawmakers could be capitalizing on people’s fear of nursing homes.

The bill could save the Medicare program $144 million to $247 million per year from avoiding nursing home stays, according to an independent analysis commissioned by the Partnership for Quality Home Healthcare.

Medicare’s current home health benefit offers part-time nursing services, in-home therapies, social services and medical supplies for 60 days. Beneficiaries aren’t eligible for home care if they need more than intermittent skilled nursing services.

The new bill, known as the Choose Home Care Act, would allow nursing home care-eligible patients the option of home care after leaving the hospital. Under the bill, beneficiaries would be able to receive nursing care, physical or occupational therapy, and speech language pathology services at home, including through telehealth.

Beneficiaries would also be able to get meals and nutritional support; remote patient monitoring; medical social services; home health aides and personal care services; respite care and family caregiver support and training; assistance with drug regimens; medical supplies and equipment for home use; nonemergency medical transportation; care coordination; and other items and services deemed necessary by the home health agency. The bill would require home care to be considered as a post-acute option during discharge planning.

The benefit would act as a substitute for the skilled nursing facility benefit, meaning it would come out of the 100 covered days a beneficiary gets in a nursing home per benefit period.

The bill would create an add-on payment for home-based extended care services, in addition to what’s paid for home health services. There would be a fixed base payment amount for 2022 ranging from $2,010 to $10,720, depending on how many hours of personal care services are provided to a beneficiary. The amount of the add-on payment would be capped at 80% of the national median 30-day payment amount for extended care in a nursing home.

The National Association for Home Care and Hospice and the Partnership for Quality Home Healthcare began to discuss a need for legislative changes earlier in the COVID-19 pandemic after realizing some providers were hesitant to discharge beneficiaries to nursing homes for post-acute care, said Joanne Cunningham, executive director of PQHH.

Bill Dombi, president of NAHC, hopes to see the bill pass through any legislative vehicle -- including the reconciliation package likely to move through Congress this fall.

“Obviously, we prefer all of Congress to support this, but if it were relegated in Congress to a reconciliation approach, the majority is in a stronger position by including things that have a bipartisan support" like the Choose Home Care Act, he said.

Home care is gaining attention from lawmakers. President Joe Biden’s social infrastructure blueprint proposed investing $400 billion in Medicaid home health. Senate Aging Committee Chair Bob Casey (D-PA) has introduced a bill, expected to be included in reconciliation instructions, that would put that vision into place.

Several beneficiary and provider groups also endorse the bill, including AARP, the National Council on Aging and LeadingAge.

“Older Americans are not a monolithic group. They have unique desires, challenges and life circumstances--and they should have access to a range of affordable care and services to meet their needs,” LeadingAge President and CEO Katie Smith Sloan said in a statement.

But the American Health Care Association/National Center for Assisted Living, the nation’s largest nursing home association, has come out strongly against the bill.

“We adamantly oppose this bill in its current form. The complex CHOOSE Home Care Act would supplant existing benefits, create duplicative payments, confuse beneficiaries, and increase out-of-pocket costs. At the same time, this legislation lacks clear quality and safety provisions, leaving patients vulnerable to inadequate care,” AHCA said in a statement.

Because home health would come out of a beneficiary's allotted days in a skilled nursing facility during a benefit period, out-of-pocket costs could arise if the beneficiary has to transfer to a nursing home after using 20 or more days at home, AHCA said. Additionally, even while at home, AHCA says beneficiaries could be subject to drug and medical equipment costs covered under Part D and Part B, as these are bundled into the SNF benefit but not home health.

Dombi said AHCA’s statement is inaccurate. The Choose Home Care Act doesn’t take any of the 100 days away from the beneficiary, and the bill’s authors built medical and drug costs into their assessment of money saved for individuals, he said.

A spokesperson for Young, one of the senators sponsoring the bill, also said the bill is designed to decrease patient cost-sharing, not increase it. The program is not designed to be for the most medically complex patients, but rather to serve as an option for those who might need a couple weeks of assistance before resuming independence, the spokesperson said.

Both Dombi and Young’s office said they’d be open to refining the bill to address co-payments for drugs and equipment.

“I think the one thing that people need to understand is that this is not an issue of competition between one provider sector and another,” Dombi said. “It really simply is giving beneficiaries, patients, a choice, and gives them a control in terms of that choice.”

However, Toby Edelman, senior policy attorney at the Center for Medicare Advocacy, said she’s sympathetic to AHCA’s argument. If this is a new benefit, it shouldn’t have to come out of the existing SNF one, she said.

Beyond that, Edelman is also concerned about how the details of the Choose Home benefit will look in practice. She feels the bill isn’t clear exactly what remote monitoring means, or how much of the services can be provided by telehealth as opposed to in-person care.

The bill specifies nursing care, physical or occupational therapy, speech-pathology and remote monitoring services could be provided through telehealth under the benefit as a supplement to daily in-person care.

Still, Edelman said the bill seems too good to be true, especially since CMA feels the existing Medicare home health benefit isn’t being properly enforced.

“I'm not saying nursing homes are a great place to be. I understand the serious quality problems. But I think this is ... capitalizing on the fear of nursing homes, and it's not really clear what it would be providing,” she said. -- Maya Goldman (

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