Medicare Home Health Care: Prospective Payment System Will Need Refinement As Data Become Available
Medicare spending for home health care rose from $3.7 billion in 1990 to $17.8 billion in 1997, making it one of the fastest growing components of the program. To control spending, Congress passed an act which required HHS to develop a prospective payment system to replace cost-based payments for home health agencies. This report: documents the objectives, findings, & costs of the research & demonstration projects the Health Care Finance Admin. has funded that were related to the design of the prospective payment system; & assesses how these projects contributed to the proposed prospective payment system design & determines which design decisions were based on incomplete information. Charts & tables.
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Abt Associates adequately adjust payments Agency Prospective Payment agency's Appendix III Comments assess budget neutrality case-mix adjustment method changes Contractor ensure evaluate expenditures Financing Administration GAO/HEHS-00-9 Home Health Health Agency PPS Health Agency Prospective Health Care Financing historical costs Home Health Agency home health aide home health payment home health PPS home health services home health users Human Services inappropriate increase level of payments medical review Medicare beneficiaries Medicare home health Medicare payments Medicare program Medicare's monitoring Nancy-Ann Min DeParle national median number of visits OASIS data Outlier payment patient needs patient outcomes payment adjustment payment method per-beneficiary amount percent phase proposed rule Prospective Payment Demonstration Prospective Payment System protect beneficiaries Ranking Minority Member refinement research and demonstration result revenue cap risk sharing risk-sharing arrangement service delivery service provision speech therapy tested therapy services treatment patterns types of patients underservice unintended consequences unit of payment utilization
Page 8 - To qualify for home health care, a beneficiary must be confined to his or her residence ("homebound"); require part-time or intermittent skilled nursing, physical therapy, or speech therapy; be under the care of a physician; and have the services furnished under a plan of care prescribed and periodically reviewed by a physician. If these conditions are met, Medicare will pay for skilled nursing; physical, occupational, and speech therapy; medical social services; and home health aide visits.
Page 8 - For purposes of receiving skilled nursing and home health aide services, "part-time or intermittent" is defined as skilled nursing and home health aide services furnished any number of days per week as long as they were furnished (combined) less than 8 hours each day and 28 or fewer hours each week (or, subject to review on a case-by-case basis as to the need for care, less than 8 hours each day and 35 or fewer hours per week). For purposes of...
Page 8 - ... confined to his home", the condition of the individual should be such that there exists a normal inability to leave home, that leaving home requires a considerable and taxing effort by the individual, and that absences of the individual from home are infrequent or of relatively short duration, or are attributable to the need to receive medical treatment.
Page 25 - HHA are adjusted at year-end in light of the provider's actual costs, to mitigate any unintended consequences of the payment change. Such an arrangement could moderate the incentive to manipulate services to maximize profits and the uncertainties associated with payment rates that are based on averages when so little is known about appropriate patterns of home health care. Limiting an HHA's losses or gains would help protect the industry, the Medicare program, and beneficiaries from possible negative...
Page 31 - If you have any questions about this report, please call me or William Shear at (202) 512-8678.
Page 8 - Background To qualify for home health care, a beneficiary must be confined to his or her residence (that is, "homebound"); require intermittent skilled nursing, physical therapy, or speech therapy; be under the care of a physician; and have the services furnished under a plan of care prescribed and periodically reviewed by a physician. If these conditions are met, Medicare will pay for part-time...
Page 8 - HHA's losses or gains would help protect the industry, the Medicare program, and beneficiaries from possible negative effects of the PPS until more is known about how best to design the PPS and the most appropriate home health treatment patterns. CBO was unable to estimate savings for this option due to a lack of data on how home health agencies' costs compare to the new payment rates implemented on October 1, 2000.
Page 39 - Medicare Home Health Care: Prospective Payment System. Will Need Refinement as Data Become Available (GAO/HEHS-00-9, Apr.