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Home care agencies in New York and across the country are routinely denying chronically ill patients access to their services, according to a report by Kaiser Health News and NPR. In many instances, the home care agency will falsely state that Medicare does not cover home care for chronic illnesses. in order to find out why, the NPR report dug a little deeper.
According to the Centers for Medicare and Medicaid Services (CMS), the government agency responsible for the healthcare programs, Medicare is required to pay for home health care if two conditions are satisfied. First, it must be ordered by the doctor. Second, the patient must have “great difficulty” leaving their home. If these two conditions are satisfied, then federal law requires Medicaid to cover home health care expenses indefinitely and without charging a copayment or deductible to the sick patient.
In many areas, especially in more rural parts of the country, there are simply not enough home health care agencies and workers to meet the needs of all chronically ill patients who wish to receive their healthcare at home. Unfortunately, even when a sufficient supply of home health care agencies exists, these companies and healthcare providers routinely deny chronically ill patients the help they need, in violation of federal law. While Medicare is allowed to reimburse up to 35 hours of home health care services each week, home health care agencies are shying away from these patients for a number of reasons, according to Kaiser Health News.
First, taking on chronically ill patients can have a negative effect on Medicare’s Home Health Compare, which allows potential patients to compare the healthcare services offered in their area. One of the “quality measures” that each healthcare facility is ranked is the level of improvement seen in each patient. Because many chronically ill patients seek to only slow their decline or maintain their quality of living, this can have a detrimental impact on their rating, which does not allow for “explanations” as to why a facility or health care providers ranking may be low in one specific area.
Second, because chronically ill patients are generally long-term patients, they can often attract the scrutiny of Medicare investigators – who may view long-term and expensive care for patients as a sign of fraud. These healthcare providers may have good reason to fear these investigations, Medicare officials have reported that almost one-third of payments to home healthcare agencies in 2017 were improper.
In response to this problem, Medicare has changed one of its rules for 2018 and will now prohibit agencies from discontinuing healthcare services paid for Medicare without a doctor’s order. Healthcare advocates worry this may backfire, though, and nursing home agencies will simply refuse to take chronically ill patients from the start, possibly worsening an already serious problem.
