Post-Election Outlook: Advocating for Home Care Provider Relief

Home-based care leaders, like everyone else, are hoping for a brighter future. Although the 2020 election is behind us, the future political landscape is not 100% clear.

What is clear is that the major issue affecting home health agencies, like most businesses in America, is the coronavirus pandemic. Business leaders in home health are hungry for economic relief and for insight into legislative and regulatory changes expected in the coming months.

Without having a crystal ball, Relias and its partner, the National Association for Home Care and Hospice (NAHC), shared perspectives on what might happen in December with the current House and Senate and in 2021 and beyond as new legislators and government leaders take office. In a recent Relias webinar, Election Impacts on Home Health Care and Hospice, William A. Dombi, NAHC President, shared his thoughts on the issues and actions drawing attention in the coming months.

Starting with the pandemic, Dombi cited recent survey data indicating that 82.4% of respondents are dealing with revenue declines, with the median falling between 15% and 20% revenue reductions.

Added Expense of COVID-19

As a plus, home care leaders and providers have shown versatility and depth by adjusting to add care for COVID-19 patients into their business. With home-based care naturally keeping patients more isolated than hospitals or skilled nursing facilities, it has become a popular option for quarantine to avoid spreading the coronavirus.

The survey indicated that 62.7% of home-based care providers are serving actively infected COVID-19 patients.

Yet, COVID-19-related costs are estimated at 9.7% higher on average. And 42% of home care agencies have less than 20 days’ supply of personal protective equipment (PPE). As patients initially declined visits amid infection worries, 47% of home care agencies have reported at least a doubling of their LUPAs, or low utilization payment adjustments.

Although the CARES Act provided $100 billion in provider relief, financial pressures are continuing to press healthcare providers. Amid the continuing need for COVID-19 care and increased costs, future stimulus funding is a laser focus among home care agencies.

The current federal government operations funding ends December 11, Dombi noted, “which means, we will see action in the lame duck session.”

Next Round of Provider Relief

In January and February, legislators will demonstrate their willingness to support future healthcare provider relief. “We see COVID-19 as the priority No. 1, No. 2, No. 3,” Dombi said.

He predicts a stimulus package that is more than the $500 billion the Senate Republicans have proposed but much less than the $2.2 trillion bill passed by the Democratic-controlled House in October. He expects an amount closer to $1 trillion.

Dombi predicts that Republican and Democratic leaders will agree on the need for relief funding and will recognize the need for good governing by putting aside partisan politics.

Advocacy for Home Health, Hospice, and Personal Care

In the coming months, NAHC will focus its advocacy efforts on the following issues.

Home Health Priorities

• Expanded provider relief fund.
• Telehealth reimbursement for home health.
• Enhanced reimbursement.
• Verbal physician orders.
• Rural add-on.
• PPE prioritization.

Hospice Priorities

• Hospice’s role in bereavement and trauma-informed care.
• Respite care in the home setting.
• A community-based palliative care model.
• Provider relief funding based on need.

Home Care Priorities

• Provider relief fund eligibility.
• Premium pay for frontline caregivers.
• Essential benefits for workers.
• Medicaid home and community-based services supports.
• Business and worker liability protections.
• PPE access.

Focusing on home health’s Patient-Driven Groupings Model (PDGM), Dombi is calling for the reimbursement rate to be increased. NAHC’s stance is that PDGM shifted reimbursements too low with the previous behavioral adjustment.

The Trump administration has been “a bit wedded to PDGM as it is now,” he said. It is unclear whether the administration of President-Elect Joe Biden will be more open to changes in PDGM’s behavioral adjustment.

NAHC is advocating for more Medicare coverage for patients who are eligible for skilled nursing facility coverage but choose to reside at home and receive care there. Another area capturing attention is allowing Medicare reimbursements for telehealth in home health settings.

Dombi also is requesting that the Centers for Medicare and Medicaid Services (CMS) explicitly provide coverage of palliative care in the home, saying, “We strongly believe that palliative care is already within the structure of the Medicare home health benefit.”

Congress’s ability to look at Medicare Payment Advisory Commission’s recommendations will be limited because of the high priority attention needed for issues related to the pandemic and the economy, he predicted.

NAHC is asking the Biden administration to consider a step back from the carve-in of the hospice benefit into the Medicare Advantage program. Dombi noted multiple issues of concern with that carve-in.

Workforce and Immigration Issues

Another priority issue is workforce pressures related to immigration. In the personal care services arena, the home care aide workforce relies on many recent immigrants to the U.S.

While acknowledging the politically sensitive nature of immigration restrictions, Dombi said, “We do see a need for opening of immigration doors in order for us to have a workforce availability to meet the demands of a Silver Tsunami.” Working in home care can allow immigrants to “take a step in, and take a step up,” he said.

Counting on Bipartisan Support

With the new Biden administration, Dombi predicts a new CMS administrator who would continue to support telehealth. He also expects continued support for having more people receive care in the community and in their homes than in institutional settings. Bipartisan issues like care in the home will be the most likely to move forward, he projected.

Dombi is optimistic that some legislative and regulatory corrections will be forthcoming because of “the nonpartisan nature of home care,” Dombi said with optimism. “It’s the kind of issue that brings parties together.”