It’s time to give Medicare beneficiaries the opportunity and choice of recovery in the home
For nearly 30 years, presidents and congressional leaders from both parties, federal and state policy makers, family caregivers, and health care providers have taken significant steps to achieve a dramatic transformation of long-term care services — moving away from institutional care and toward developing and supporting more home-based services. These efforts have made the lives of millions of children, seniors, and persons with disabilities much better as they can live in their own homes in close connection with their families, friends and the community.
Recently, in addressing the COVID-19 pandemic, Congress and the Department of Health and Human Services provided unprecedented flexibilities to support more care in the home. Innovative but temporary flexibilities that lift restrictions for home care and telehealth services, along with legislation giving nurse practitioners the ability to certify Medicare home health benefit eligibility, are just some of the reforms helping more patients recover in their home after an illness or surgery.
We believe now is the time for Congress to bring the value of health care at home to Medicare beneficiaries by establishing an option for individuals to recover at home following a hospitalization while retaining the existing option of care in a skilled nursing facility. Medicaid has proven for nearly 30 years this can be a clinically sound approach to care as well as one that saves millions of dollars. It is time to bring this modernization to Medicare too.
That is why we, and other congressional colleagues, filed legislation titled the Choose Home Care Act of 2021. This legislation provides medically appropriate patients the option to leave the hospital and recover at home rather than being discharged to a skilled nursing facility, the only current option under Medicare. This construct may have fit in 1965 when Medicare started, but it is long out-of-date. Moreover, in Texas, there are over 1,200 Skilled Nursing Facilities (SNF). In Kentucky, there are nearly 300 facilities—but not everyone lives close to these facilities. This legislation provides options for those that don’t have access to SNFs, with support and rehabilitative services at home.
For the first time, this important legislation provides a time-limited, cost-effective benefit which
combines Medicare-covered skilled nursing and therapy with essential personal care, transportation, meal supports, remote patient monitoring, respite care, telehealth, and other services. By combining this set of extended care services with traditional Medicare home health, seniors can leave the hospital and recover at home with increased patient and family satisfaction and reduced exposure to infectious disease — as well as significant savings to Medicare when compared with institutional costs.
How would this program work? Eligibility would be controlled by use of an assessment process that considers an individual’s place-of-care preferences, their medical conditions, and most importantly, the patient’s goals and family caregiver abilities regarding care. Studies show between 10 and 20 percent of patients who are eligible for skilled nursing facility care have medical conditions that can be cared for in the home.
Upon hospital discharge, eligible patients would be referred to a qualified home health agency offering home-based extended-care benefits. Services under the Choose Home legislation would be covered for up to 30 days, but skilled home health services may continue beyond the initial 30 days, as necessary.
Who among us would not appreciate having the opportunity and choice of recovery in our home? It is time to give Medicare beneficiaries that choice.
We are excited with the positive reception this initiative is receiving from the patient and family caregiver community, from providers, and from organizations such as AARP, the National Council on Aging, Allies for Independence, Leading Age, and other important veterans and disabilities groups. Our Senate colleagues – Sens. Debbie Stabenow (D-Mich.) and Todd Young (R-Ind.) – filed the identical bill in their chamber with multiple co-sponsors from both parties.
We are proud to come together in a bipartisan manner to introduce the Choose Home Care Act of 2021 – a much-needed reform that provides our nation’s seniors and their families with the choice to receive quality health care in the comfort and safety of their own homes.
Henry Cuellar represents the 28th District of Texas and James Comer represents the 1st District of Kentucky.
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