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Spotlight on the Choose Home Care Act: Saving Grace or Falling Short?

Though reimbursement structure around remote patient monitoring (as well as telehealth and telemedicine) offerings has been evolving over the past two decades, one of the glaring areas of oversight has been in home health. Prior to the pandemic, (reimbursable) extended care following an event in the hospital was limited to a skilled nursing facility (or SNF).

But like so many things – the pandemic changed everything. And now supporting legislation has significant promise, highlighted in the recently-introduced Choose Home Care Act of 2021.

The proposed legislation was a recent topic of conversation with Home Health Care News journalist Bob Holly, on a recent episode of the Vital Insights podcast series. As a journalist with a passion for digging into the details when it comes to interpreting new legislative initiatives that support aging in place, Bob framed the Act’s benefits simplistically.

“At a very basic level, what [the Choose Home Care Act] does is allows patients who are coming out of the hospital to choose in-home care instead, as an alternative to a nursing home,” said Bob. “And from a payment perspective, it does that through an add-on, essentially creating a new pathway for reimbursement, while also saving the system hundreds of millions of dollars.”

According to the National Association for Home Care & Hospice (NAHC), “The COVID-19 pandemic has vividly shown the limitations and risks of SNFs. Beyond the pandemic crisis, extended care at home also makes sense, and the Choose Home Care Act supports patients as they leave the hospital and recover at home with a mix of expanded skilled nursing, therapy, personal care, telehealth services and more. In this way, eligible patients can choose to recover at home in a safe home environment with appropriate and sufficient care tailored to meet their individual needs and reduced Medicare spending.”

Broken down further, details of the Choose Home Care Act include:

· Patient meets SNF benefit eligibility and resides at home;

· The patient would receive traditional home health benefit services and (for 30-days) an expanded package of services including transportation, meals, home modifications, remote patient monitoring, telehealth services, and personal care services;

· The reimbursable amount combines the home health amount and fixed add-on for expanded services, with add-on payments capped at about $4,623 per patient.

And as Bob discusses in his podcast, the estimated savings represent substantial benefit to the system: According to Dobson Davanzo, an independent health economics firm, this legislation will generate Medicare savings of $144-247 million per year (or $1.6-2.8 billion in savings over 10 years).

And home health providers anticipate the demand from patients and hospital partners would be higher, potentially producing even higher annual savings to Medicare of closer to $925 million a year.

In addition to the wide bipartisan support the bill has received congressional sponsorship, it is also supported by organizations such as AARP, NAHC, Leading Age, the National Council on Aging (NCOA), Allies for Independence and several other advocacy groups.

And perhaps most importantly, it has widespread appeal among those who would utilize the benefit – namely older Americans who prefer to age in place.

Reporting on a new public opinion poll this past week, Bob noted that “more than nine out of 10 of the Medicare beneficiaries who took part in the poll said they would prefer to receive post-hospital short-term health care at home. Additionally, 85% of adults from the poll said it should be a high priority for the federal government to expand Medicare coverage for at-home health care.”

“This important poll confirms the growing public support for improved opportunities to ‘age in place’ with health care in one’s own home,” said William A. Dombi, president of NAHC. “The Choose Home legislation provides such an opportunity with high-quality care that reduces Medicare spending while fulfilling patient preferences. It is a timely modernization of Medicare.”

Initially introduced this past July by U.S. Sens. Debbie Stabenow (D-Mich.) and Todd Young (R-Ind.), the bill just advanced with its introduction to the House this past Friday, October 8. You can read more about its progress in Bob’s developing story on the subject, as well as through his podcast on Vital Insights.