3 Million Benefit From Medicare Home Care Services

Some 3 million individuals benefit from Medicare Home Care Services 2023. The Medicare program spent $16.9 billion (latest figures) with 11,474 Home Health Care agencies participating in the Medicare program.

This information comes from the March 2023 report and funding proposal published by the Medicare Payment Advisory Commission (MedPAC). MedPAC recommends that Congress reduce the 2023 Medicare base payment rate for home health agencies by 7 percent.

The proposed cut will decrease federal program spending by $750 million to $2 billion in 2024 and by more than $10 billion over five years.

MedPAC is an independent congressional agency established by the Balanced Budget Act of 1997. It advises the U.S. Congress on issues affecting the Medicare program.

What Is Medicare Home Health Care (HHC)?

Medicare HHC consists of skilled nursing, physical therapy, occupational therapy, speech therapy, aide services, and medical social work provided to beneficiaries in their homes.

In 2021, about 3.0 million Medicare fee-for-service (FFS) beneficiaries received HHC services.

Eligibility Criteria

To be eligible for Medicare’s home health benefit, beneficiaries must need part-time (fewer than eight hours per day) or intermittent skilled care to treat their illnesses or injuries. They must be unable to leave their homes without considerable effort.

As compared to Medicare coverage for skilled nursing facility services (nursing homes), Medicare does not require a preceding hospital stay to qualify for home health care (HHC). Also, unlike for most services, Medicare does not require copayments or a deductible for home health services.

Medicare does require that a physician, nurse practitioner, clinical nurse specialist, or physician assistant certify a patient’s eligibility for HHC benefits. Medicare also requires that a beneficiary have a face-to-face ‘encounter’ with the practitioner ordering home health care.

That physical meeting must take place in the 90 days preceding or 30 days following the initiation of home health care. Telehealth services may now be used to satisfy the requirement.

Beneficiary Usage Declines Slightly

The MedPAC report indicated that the number of Medicare FFS beneficiaries using home health care declined by 1.1 percent in 2021. The volume of 30-day periods declined 2.9 percent.

The researchers explained factors that likely accounted for the decline. In particular, they attribute the decline to increased enrollment in Medicare Advantage plans. The report also notes that as a result of the Covid pandemic, many home health care providers have reported that staffing shortages limit the volume of services they can provide.

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