Lymphedema Compression Treatment Items: New DMEPOS Benefit Category

Starting January 1, 2024, Medicare pays for lymphedema compression treatment items for Medicare Part B patients. CMS updated the following manuals with information on this new DMEPOS benefit category:

• Medicare Benefit Policy Manual, Chapter 15 (PDF):
• Section 110.8: DMEPOS benefit category determinations
• Section 145: covered items, replacements, and frequency limitations
• Instruction to your Medicare Administrative Contractor (PDF)
• Medicare Claims Processing Manual, Chapter 20 (PDF): 
• Section 181.1: payment policy
• Instruction to your Medicare Administrative Contractor (PDF)

Debbie Stabenow, Susan Collins Advocate Against Home Health Payment Cuts In Letter To CMS

Home Health Care News / By Andrew Donlan  

Sens. Debbie Stabenow (D-Mich.) and Susan Collins (R-Maine) recently sent a letter to Centers for Medicare & Medicaid Services (CMS) Administrator Chiquita Brooks-LaSure, urging her and the agency to avoid cuts to home health payment as it nears time to release a proposed rule for 2025. 

“We appreciate CMS’ commitment to helping people get the care they need, where they need it.

This must include home health services for people with Medicare,” the senators wrote. “As CMS proceeds to develop Medicare home health payment rates for 2025, we urge you to consider the value home health care provides to the Medicare program and its beneficiaries.”

Generally, the home health payment rule proposal comes out sometime in June, with the final rule coming out at some point in late October or early November.

Since the implementation of the Patient-Driven Groupings Model (PDGM) in 2020, home health providers have seen steep and permanent cuts to payment. For instance, over the last two years, providers have seen cuts of 2.890% and -3.925% materialize.

“We are concerned that CMS recently finalized home health payment methodology that has led to steep cuts, essentially canceling out market basket updates intended to help Medicare payments keep up with inflation,” the senators continued. “Under this methodology, Medicare home health payment rates have been stagnant over the past three years, and CMS has indicated that further cuts are planned.”

The Partnership for Quality Home Healthcare (PQHH) released a data brief to illustrate how severe the cuts’ impact would be over the next five years – if not mitigated – in late April.

On Friday, PQHH commended Stabenow and Collins for taking action.

“Senators Stabenow and Collins are true champions for Medicare home health, and we applaud their continued leadership to protect the Medicare benefit and access to home-based healthcare for older Americans,” PQHH CEO Joanne Cunningham said in a statement. “We urge CMS to listen to the Senators’ advice to ensure beneficiary access to home health is prioritized in their rulemaking.”

Medicare Go-Broke Date Extended to 2036, but Warning Bells Continue Ringing

Healthcare Dive / By Pifer

The Medicare trustees’ new projection for insolvency is five years later than previous forecasts, but budget hawks warned action is still needed to shore up the insurance program’s finances.

Dive Brief:

• A key trust fund underpinning the massive Medicare program has a new insolvency date: 2036, according to a new report from the Medicare trustees.
• That’s five years later than the go-broke date in last year’s report, thanks to more workers being paid higher wages causing more revenue to flow into the trust fund’s coffers, along with lower spending on pricey hospital and home health services.
• Still, looming insolvency absent action in Washington remains a serious source of concern for the longevity of Medicare, which covers almost 67 million senior and disabled Americans, according to budget hawks.

Dive Insight:
 
Dire predictions in the annual Medicare trustees report have varied in the past few years. In 2020, in the early throes of COVID-19, the board predicted the Hospital Insurance Trust Fund fund would run out by 2026. That deadline was pushed back to 2028 and then 2031 in subsequent years’ reports, amid a broader economic rebound and more care shifting to cheaper outpatient settings.
 
Now, the trustees — a group comprised of the Treasury, Labor and HHS secretaries, along with the Social Security commissioner — are forecasting an additional five years of breathing room for Medicare solvency.
 
Along with the healthier economy, that’s in part due to the Inflation Reduction Act passed in 2022, which restrains price growth and allows Medicare to negotiate drug prices for certain Part B and Part D drugs, and should lower government spending in the program overall, according to the report.
 
The Hospital Insurance Trust Fund, which pays hospitals and providers of post-acute services, and also covers some of the cost of private Medicare Advantage plans, is mostly funded by payroll taxes, along with income from premiums.

The HI fund is separate from another trust fund that covers benefits for Medicare Parts B and D, including outpatient services and physician-administered drugs. That Supplemental Medical Insurance trust fund is largely funded by premiums and general revenue that resets each year and doesn’t face the same solvency concerns.
 
In 2023, HI income exceeded spending by $12.2 billion. Surpluses should continue through 2029, followed by deficits until the fund runs out entirely in 2036, according to the report.
At that point, the government won’t be able to pay full benefits for inpatient hospital visits, nursing home stays and home healthcare.
 
Spending is projected to grow substantially in Medicare largely due to demographic changes…

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House Committee Greenlights New Bill that Would Extend Hospital-at-Home, Telehealth Flexibilities

McKnight’s Home Care / By Adam Healy
 
A House Ways & Means health subcommittee on Wednesday unanimously approved a new bill that would extend the Acute Hospital Care at Home waiver by five years and pandemic-era telehealth flexibilities by two years. 
 
The subcommittee’s bipartisan group of lawmakers voted 41 to 0 in favor of the “Preserving Telehealth, Hospital and Ambulance Act,” which was introduced on Tuesday. Representatives called out the need to extend the hospital-at-home waiver, which is set to expire at the end of 2024. 
 
“Without this bill, beneficiaries will no longer be able to talk to their doctors or receive acute hospital care from the comfort of their home starting at the end of this year,” Rep. Jason Smith (R-MO) said during the hearing. “Only a few short years ago, these possibilities seemed unthinkable, but are now revolutionizing care for seniors on Medicare and those living in rural areas.”
 
The Centers for Medicare & Medicaid Services created the Acute Hospital Care At Home Waiver in November 2020 to free up hospital bed supply during the COVID-19 pandemic. In the years since, the hospital-at-home program has expanded. More than 300 hospitals across 129 health systems in 37 states are operating under the waiver. In March, more than 50 hospitals and home care firms sent a letter to House lawmakers asking them to extend the program. 
 
Policymakers on Wednesday also approved of the bill’s support of telehealth flexibilities instituted during the COVID-19 pandemic. These flexibilities allow any Medicare-certified healthcare provider to furnish telehealth services to patients, even across state lines. The pandemic-era allowances are also set to expire at the end of the year, and likewise, stakeholders have called on policymakers to pass an extension.
 
Some lawmakers even expressed interest in making telehealth a permanent fixture in Medicare-covered services…

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