We Mainers often think of ourselves as wonderfully independent. We cherish the choice to live our lives the way we want and take pride in the strength of our communities. Part of that means choosing to remain in our homes as we get older, which requires access to health care services delivered in the home setting. Yet choice and community could be undermined by a new federal regulation that could restrict access to home health for Mainers dependent on the Medicare program.

On the state level, home care has recently been central to policy discussions surrounding the “Universal Home Care” debate, which fostered an important conversation around access to home care at a time when our state’s population is aging. Now, we are facing an equally important conversation on the federal level being led by Sen. Susan Collins.

A new Medicare payment model put in place by the federal Centers for Medicare & Medicaid Services (CMS) threatens to interrupt access to the home health nearly 20,000 Mainers rely on to remain in the home. The policy specifics are complicated but could have a significant impact on the delivery of home health services to Medicare beneficiaries across out state.

Under the new payment structure called the Patient-Driven Groupings Model (PDGM) Medicare will soon begin to make “behavioral adjustments” to provider payments based on assumptions about what those directing care might do instead of evidence of how they actually serve Medicare patients. Even before tracking how provider billing changes based on the new payment model, Medicare has indicated it will cut reimbursement rates across the board by 6.42 percent or roughly $1 billion nationally in 2020.

Though the new payment model is designed to help root out fraud and overbilling two laudable goals it will collectively punish the hardworking health home care agencies that serve Mainers, particularly those serving the most rural parts of our state.

Recognizing the risks this payment model places on Maine seniors, Sen. Collins, a longtime champion of home health care, recently introduced the bipartisan Home Health Payment Innovation Act of 2019 (S. 433) in the U.S. Senate, which will refine the new payment model to ensure Medicare reimbursement rates are based on observed behavior and data instead of mere assumptions. This approach will ensure Medicare payment is based on real patient characteristics and care needs.

Without these critical changes, Sen. Collins recently said the PDGM “would be very unfair to many home health care agencies, particularly those in more rural areas where the home care providers may have to travel great distances to see their patients, meaning their volume isn’t going to be as high.”

For millions of seniors across the country, home health is both meaningful and valuable. It enables them to be treated in the comfort, safety and privacy of their own homes. We applaud Senator Collins for her leadership in protecting Mainers’ Medicare benefits and urge all of our lawmakers to support S. 433 to preserve the timely, seamless and consistent delivery of cost-effective, patient preferred home health.

 

Laurie Belden is executive director of the Home Care & Hospice Alliance of Maine in Manchester.

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