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New Medicare payment rules for home health agencies serving Medicare beneficiaries will likely further reduce access to care for people with longer term and chronic conditions.

Medicare will pay agencies significantly more for services provided to beneficiaries within the first 30 days following inpatient institutional care (hospital or skilled nursing facility), than for those who begin home care without an inpatient stay. Further, agencies that provide ongoing care for people with longer term and chronic conditions will receive significantly lower payments for those services, thus reducing – if not altogether removing – access to care for those individuals.

For beneficiaries who qualify, Medicare home health law authorizes coverage with no duration of time limitation; not the 30 days contemplated in the new payment rule. Further, the law provides the same coverage for all people, regardless of whether a hospitalization took place or if a physician in the community ordered home health services for an individual living at home.

For many years, through payment and quality rules, CMS has been moving the Medicare home health benefit toward short term, post-acute care coverage, despite coverage laws that provide equally for individuals with longer term and chronic conditions. These new payment rules will accelerate the discrepancy between services Medicare legally covers and services beneficiaries are able to obtain.

The final rule can be found at:

It will be published in the Federal Register on November 13, 2018. The Center for Medicare Advocacy will provide further analysis of the impact of the final rule in future Alerts.


November 1, 2018 – K. Holt

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