Legislative Update: February 26, 2019

In the post-acute arena, two legislative proposals were recently introduced that impact access to and reimbursement for Medicare home health services. The first proposal is the “Home Health Payment Innovation Act of 2019 (S.433),” which was introduced by Senators Collins (R-ME) and Stabenow (D-MI) on February 11, along with five other Senators. 

S. 433 includes two key components. First, the legislation would waive homebound rules for services provided to individuals enrolled in Medicare shared savings programs, such as accountable care organizations (ACOs), as well as for beneficiaries enrolled in the Medicare Advantage program. Under the proposal, homebound rules would continue to apply for services provided to Medicare fee-for-service enrollees.

Second, the legislation would modify the new Medicare Patient-Driven Groupings Model (PDGM) by requiring that the new payment system be implemented in a “budget neutral manner.” Specifically, the legislation would prohibit the Secretary from modifying Medicare home health payment rates based on assumptions of inappropriate case mix changes that could occur under the new PDGM system. Instead, the legislation would require the Secretary to implement payment modifications based only on actual experience and data generated after PDGM is implemented in 2020. In addition, the legislation would limit payment increases or decreases to no more than 2.0 percent per year, with any greater modification being phased in over a number of years. 

The second piece of legislation introduced is the “Home Health Planning Improvement Act (S. 296).” This legislation would allow non-physician providers to certify patients for Medicare home health benefits. ElevatingHOME, others in the home care sector, as well as a host of nursing organizations have been long-standing supporters of this important legislation, which will increase access to care, particularly in underserved communities. 

Finally, on February 19, Rep. Joe Courtney (D-CT) re-introduced the “Workplace Violence Prevention for Health Care and Social Service Workers Act (H.R. 1309).” The legislation would require certain employers in the health care and social service sectors to develop and implement a comprehensive workplace violence prevention plan. 

The legislation specifically requires the Occupational Safety and Health Administration (OSHA) to issue a proposed rule within one year and then a final rule within 42 months that will establish workplace violence prevention standards. These standards would apply to a wide swath of care settings, including: inpatient and outpatient hospitals; nursing homes; hospice programs; any community care setting, such as mental health clinics; and to any care provided via home health, home-based hospice and home-based social work; as well as to other service areas and settings. The new rules would not apply to an individual who privately employs a person to perform services in an individual’s home. 

The legislation further requires that employers develop the plan in cooperation with direct care employees, which must include reporting and post-incidence investigation protocols. It also requires that summary of illness and injury logs be made available for employees to review. 

At this time, 24 other House Members have signed on as supporters and a number of national organizations have endorsed the bill, including the American Federation of Teachers, the AFL-CIO, National Nurses United and the American Nurses Association. ElevatingHOME has also signed on as a supporter of this important legislation. It is anticipated that H.R. 1309 will receive Committee consideration in the coming weeks.

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