Two months after Democrats unveiled a policy framework to add a home care benefit within Medicare, lawmakers introduced a bill that, if passed, would make the benefit a reality.
The new bill, called the Medicare At Home Act, would add a home care benefit to Medicare Part B.
“Americans overwhelmingly and strongly believe Medicare should cover home care services, with 93% of adults agreeing,” the bill text reads. “A modest, capped home care benefit under Medicare would allow older adults and people with disabilities to remain safely in their homes and communities. It would also take the pressure off of unpaid family caregivers who now provide $1 trillion in unpaid care to the economy, filling in gaps in the systems.”
U.S. Rep. Debbie Dingell, D-Mich., and U.S. Sen. Andy Kim, D-N.J. introduced companion bills on Aug. 10.
“This bill gives families peace of mind by ensuring Medicare covers the essential in-home support people need to live with independence and dignity,” Dingell said in a statement. “It is a common-sense solution that makes care more affordable for people on Medicare.”
The bill would add home care benefits, including assistance with activities of daily living (ADLs), such as bathing, dressing and eating, as well as assistance with “instrumental” ADLs, such as meal preparation and light housekeeping.
These services would be separate from Medicare home health services.
The benefit would cover home care services up to 20 hours a week. A physician or other authorized practitioner would create and periodically review a plan of care, which would have to certify that the beneficiary requires assistance with at least two ADLs, two instrumental ADLs or one ADL and one instrumental ADL.
The bill would establish a payment methodology for home care services that would reflect a “reasonable wage floor” for home care workers.
If passed, the home care benefit would not take effect immediately. It would direct the Department of Health and Human Services (HHS) to issue regulations within one year of enactment and for the benefit to apply beginning with the first plan year that starts more than two years after the bill is enacted. It would also direct HHS to adjust monthly Medicare Part B premiums to reflect the benefit’s additional cost.
Reactions to Medicare home care benefit
LeadingAge, Caring Across Generations, Justice in Aging and other advocacy groups voiced their support for the Medicare At Home Act.
“The Medicare at Home Act sets an agenda and important focus for the future by expanding Medicare coverage to include personal care services in the home–a critical need that many older adults and families mistakenly assume is paid for by the current Medicare benefit,” Katie Smith Sloan, President and CEO of LeadingAge, said in a statement. “We look forward to working with Congresswoman Dingell and Senator Kim to address this shortcoming in access and affordability while also ensuring our nonprofit and mission-driven members are equipped to deliver high-quality care wherever people call home.”
Providers and industry advocates have championed the idea of a Medicare home care benefit.
Arsen Ustayev, founder and CEO of CareChoice, previously told Home Health Care News that he would love a Medicare home care benefit “more than anything.”
“One of the problems that Medicaid has is that it is a state-administered program, and so it is different in every state,” he said. “On the other hand, skilled home health is basically guided by CMS, so the regulations are made by CMS – it’s the same in every state, which is awesome. If I’m doing something in Florida, and I can just go to Pennsylvania and repeat it, because I don’t have to worry about a whole new set of regulations. … It’s questionable whether they’ll ever get [the Medicare home care benefit] done, but if they do, I think it would be awesome.”
Wyncote, Pennsylvania-based CareChoice provides personal home care, adult day and skilled home health services in Florida, Pennsylvania, Michigan and Texas.
While enthusiasm for the benefit abounds, experts told HHCN after the introduction of the earlier, broader framework that any Medicare home care benefit would need a thoughtful design. They said a broader benefit could include home- and community-based services such as personal care, transportation and adult day services and should reflect the cost of delivering care.
“That means adequate reimbursement, reasonable administrative requirements, clear eligibility rules, and recognition of the workforce challenges providers are already facing,” Jason Lee, CEO of the Home Care Association of America, previously told HHCN. “A benefit that is underfunded or overly burdensome would not solve the access problem families are experiencing.”