Due to certain rule changes regarding Medicare reimbursements, some in-home health care services are no longer being provided by various agencies across the country. On January 1, 2020, the Center for Medicare and Medicaid Services (CMS) implemented a new rule where it would no longer cover therapeutic services for patients who have diagnoses from which they are unlikely to recover (or who would need these services long-term, with no discernible end date in view).
This includes physical, speech, and occupational therapies. That means for men and women, regardless of age, if they have been diagnosed with some health issue or disease that they are not likely to recover from, these types of services might no longer be covered by Medicare.
Many of the clients who had been depending on these in-home care services have been completely caught off guard, surprised by the announcement from their direct provider that these services are no longer covered and will no longer be provided.
These changes are a complete separation from the way Medicare’s home health care rates had been reflected, determined, and reimbursed.
According to Kaiser Health News, in its blog, Why Home Health Care Is Suddenly Harder To Come By For Medicare Patients:
“Previously, Medicare’s home health rates reflected the amount of therapy delivered: More visits meant higher payments. Now, therapy isn’t explicitly factored into Medicare’s reimbursement system, known as the Patient-Driven Groupings Model (PDGM).
Instead, payments are based on a patient’s underlying diagnosis, the presence of other complicating medical conditions, the extent to which the patient is impaired, whether he or she is referred for services after a hospitalization or a stay in a rehabilitation center (payments are higher for people discharged from institutions) and the timing of services (payments are higher for the first 30 days and lower thereafter).”
The focus now among home care agencies who depend on Medicare and Medicaid reimbursements for financial purposes will likely focus more on short-term therapies and support services.
For those elderly and disabled individuals who may require significant, long-term physical, occupational, and speech therapy, there seems to be a significant drop in incentive for agencies and other providers to continue offering these services.
It is believed that some home health agencies and providers were offering too much therapy under the previous system, but this new change may lead to an unfortunate drop in necessary support services moving forward.
While the focus may be saving money, the question resounds: at what cost? Also, another important and pressing question could be: who ultimately decides which individuals are worthy of these therapeutic in-home care services in the future?
Latest posts by Valerie VanBooven, RN BSN, Editor in Chief of HomeCareDaily.com (see all)
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