New Rule May Make It Harder for Medicare Beneficiaries to Receive Home Care
It may become harder for Medicare beneficiaries to find home health care due to a new rule from the Centers for Medicare and Medicaid Services (CMS). Although the rule changes the way home health care providers are reimbursed, it could affect patient care as well.
Posted on August 28, 2019
Starting in January 2020, Medicare will reimburse home health agencies at a lower rate when they care for patients who have not been admitted to a hospital first. CMS estimates that it will pay home health agencies approximately 19 percent more for a patient who hires the home health agency directly after leaving a hospital than a patient who was never in the hospital or was only an outpatient. (The Center for Medicare Advocacy calculates that the disparity could be as high as 25 percent.)
In part due to pressure from Medicare to reduce costly inpatient stays, hospitals often do not admit patients, but rather place them on observation status to determine whether they should be admitted. These patients, if not admitted to the hospital for at least three nights, are not eligible for Medicare reimbursement of a limited amount of skilled nursing care and typically head home instead to continue care with Medicare’s home health care benefit.
But a home health agency that cares for a patient who was in the hospital under observation will be reimbursed as if the patient had been an outpatient. This lower reimbursement rate means that home health agencies may be reluctant to provide care for patients who were under observation status or who haven't been in a hospital at all.
If you are hospitalized, it is important to learn whether you are admitted or under observation. Hospitals are required to provide notice to patients if they are under observation for more than 24 hours.
For more information about the new rule from the Center for Medicare Advocacy, click here.
More from our blog…
Could Medicaid Payback Rules Come to an End?
Amid recent reports from such prominent news outlets as The New York Times and Associated Press about the negative impact of Medicaid estate recovery on families, the idea of [...]
Seniors and Caregivers: Establish an Emergency Action Plan
For seniors and their caregivers, having a plan in place should an emergency strike can provide some peace of mind in a turbulent world. A [...]
5 Ways to Update Your Estate Plan After a “Gray” Divorce
Deciding to end a marriage as an older adult is increasingly common. If your marriage ended later in life, you could be part of the [...]
Survey Highlights High Costs of Long-Term Care in 2023
You may not foresee ever needing assistance with your day-to-day life. However, research shows that seven in 10 adults aged 65 and older will require [...]
Recent blog posts
FREE WEBINAR
5 Things to Know About
Estate Planning
When You Turn Sixty-Five