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Industry, Advocates Urge Committee to Nix Proposals to Increase Medicare Cost Sharing

Published by BNA
August 21, 2013


In comments to the House Committee on Ways and Means, groups representing home health agencies rejected the concept of a Medicare copayment for home health services.

“Congress eliminated the home health copayment in 1972 for the very reasons it should not be resurrected now,” the National Association for Home Care & Hospice said Aug. 14 in a letter to the House Committee on Ways and Means. “Reinstating the home health copay today would undo the progress made in efforts to reduce unnecessary hospitalizations and nursing home stays.”

Similarly, the Partnership for Quality Home Healthcare said in an Aug. 16 letter that, because of the “low income of the Medicare home health beneficiary population,” patients would forgo services, which would worsen health problems and lead to “delivery of treatment in institutional settings, which costs significantly more than do home-based clinical services.”

Medicare Cost Cutting
The two industry organizations were responding to the committee's request for comments on ways to cut Medicare costs. A $100-per-episode home health copayment starting in 2017 was one of three policy proposals that were the subject of a July request from committee Republicans for comments. It was estimated the copay would save $700 million (140 HCDR, 7/22/13).

The three policy options, which were part of President Obama's 2014 proposed budget, would increase beneficiary cost sharing. One of the other proposals would increase income-related premiums for Medicare Part B and Part D; the other would increase the annual Part B deductible for new enrollees.

Comments were due Aug. 16.

Coalition Letter
An Aug. 16 letter from a 13-member coalition that included the two home health industry groups, along with groups representing disabled Americans, including Easter Seals and Vietnam Veterans of America, said cost-saving policy should focus on eradicating fraud, not increasing out-of-pocket costs.

“Imposing additional costs on a vulnerable population of older Americans is not a solution that will stabilize this vital program,” the Fight Fraud First! coalition wrote to Rep. Dave Camp (R-Mich.), the Ways and Means Committee chairman, and Rep. Sander M. Levin (D-Mich.), its ranking member. “We instead urge lawmakers to advance policy solutions that will safeguard beneficiaries through program integrity reforms.”

AARP, in an Aug. 16 letter, told Camp that “[p]roposals which force beneficiaries to pay more, without improving the value and quality of care received, essentially punish the beneficiary for being sick.”

The policy option that calls for increasing the income-related premiums for Parts B and D does not reflect a beneficiary's current situation, AARP said.

Medicare determines which beneficiaries are subject to the income-related premium by looking at the beneficiary's tax return from the prior year.

“Thus, new retirees (whose income is likely to have dropped precipitously from their working years) would be subject to higher income-related premiums based on their previous wages, not their current financial situation,” AARP said.

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