Post-acute care refers to a range of services that support the individual’s continued recovery from illness or injury, or management of a chronic illness or disability. On June 19, 2013 the House Ways and Means Committee and Senate Finance Committee issued a letter to key communities requesting information and ideas on the types of long-term post-acute care reforms that would improve quality and improve program efficiency. The letter requested comments and suggestions on a variety of options for reforming post-acute care, including quality measures, assessment tools, payment modifications, and beneficiary protections.
Following a hospitalization or other care for injury or illness, many patients require continued medical care, at home, in the community, or in a specialized facility. Medicare spending on post-acute care in 2011, which included payments to skilled nursing facilities, home health agencies, long-term care hospitals and inpatient rehabilitation facilities, was $62 billion. The cost to the Medicare program of providing post-acute care has made it a target for policy-makers seeking to reduce program spending.
The Center for Medicare Advocacy, joined by the National Senior Citizens Law Center, the National Committee to Preserve Social Security and Medicare and the National Consumer Voice for Quality Long-Term Care submitted broad comments with a focus on how to preserve and strengthen post-acute care services for beneficiaries. In particular, the Center stressed that:
- Legislative proposals to reform Medicare post-acute care should not be paid for by shifting costs to beneficiaries, including through the imposition of home health co-pays or other restrictions on Medicare home health coverage.
- Congress should seek to improve access to post acute (and long-term) care, particularly through the elimination of outpatient therapy caps and the three day prior inpatient hospitalization requirement for coverage of skilled nursing facility care.
- Financial incentives seeking to reduce utilization of post-acute care services should be focused on providers, rather than beneficiaries. Often, once beneficiaries seek care and are engaged in the health system, doctors and other medical providers, not patients, drive the number and types of services that are delivered. Beneficiaries should not be held solely or primarily responsible for reducing unnecessary, duplicative or ineffective care.
Medicare Reform Proposals
The House Ways and Means Subcommittee on Health also solicited input from stakeholders on various draft proposals that seek savings for the federal government in the Medicare program. These proposals include further means-testing Medicare premiums, increasing the Part B deductible, and adding a home health copayment. The Leadership Council of Aging Organizations, which includes the Center, submitted comments in strong opposition to these proposals  and any others which produce short-term savings by shifting costs to people who rely on Medicare, half of whom live with incomes under $22,000. Among other facts, LCAO’s comments highlight several key points, including:
- More means-testing of Medicare premiums strikes at the heart of the middle class.
- Increasing the Part B deductible harms the poorest and deters access to needed care.
- Adding a home health copayment deters care for the sickest and increases the need for higher-cost levels of care.
LCAO also emphasizes its support of cost-saving solutions that build on system-wide delivery reforms that reduce the rate of health spending by addressing the systemic causes of cost growth, while noting that in recent years, Medicare has led the way in reducing rates of cost growth.
Policymakers continue to propose cost-saving measures at the expense of Medicare beneficiaries. Once again, the Center for Medicare Advocacy urges Congress to adopt real, common-sense solutions that would reduce costs without harming Medicare and those who depend on it.
 Letter from House Ways and Means and Senate Finance Committee to stakeholders seeking input on Medicare post-acute care (June 19, 2013), available at http://waysandmeans.house.gov/uploadedfiles/pac_letter_final_w_signatures.pdf.
 See https://www.medicareadvocacy.org/comments-on-post-acute-care-pac-reform-proposals/.
 See https://www.medicareadvocacy.org/letter-to-ways-means-committee-re-cost-sharing-proposals/.