Why Political Roadblocks Threaten Home Health Care’s Biggest Policy Objectives

Policy concerns in home-based care are considered timely and critical for those in the industry. The issue is, unfortunately, they aren’t always viewed in that light by outsiders and lawmakers in Washington, D.C.

Among those concerns are the extension of the Acute Hospital Care at Home waiver, adequate reimbursement for telehealth and the Choose Home Care Act.

“There is a level of gridlock and partisanship in Washington, D.C., that’s created a limited number of opportunities, which is disappointing,” William A. Dombi, president of the National Association for Home Care & Hospice (NAHC), said during a Home Care 100 panel discussion earlier this month. “But I think we are extraordinarily well positioned. And maybe in March, there will be opportunities for further legislation.”

Choose Home is still awaiting a score from the Congressional Budget Office (CBO), which similarly, has a lot on its plate. If Choose Home’s passage were put to Vegas odds, Dombi said that advocates are certainly “not playing with house money.” He did, though, give it an “even” chance of passing this year – meaning about 50%.

As for hospital-at-home legislation that would extend the Acute Hospital Care at Home waiver – which is tied to the public health emergency (PHE) – Dombi and others are more bullish.

A handful of senators have already drafted legislation to extend it, according to Alison Armstrong, the executive director of Moving Health Home.

The Washington, D.C.-based Moving Health Home is an advocacy organization that vies for favorable legislation for home-focused health care providers.

“Legislative language is already drafted,” Armstrong said during the panel discussion. “What we’re hearing is that there’s widespread, bipartisan support. The biggest pushback we’re hearing from the Hill offices has to do more with the data coming out of the program, which they view as limited.”

More time will bring more data, which is part of the reason why advocates believe the waiver should be extended.

Telehealth reimbursement

Home health care providers have been granted more flexibilities relating to telehealth during the PHE, but are still not fully paid for their remote visits.

It’s been advocated for on a non-stop basis over the last two years, and yet there hasn’t been much tangible progress. And there’s a reason for that.

“From a Medicare home health perspective, you’ve got a roadblock,” Dombi said. “The statute itself prohibits payment for telehealth services within the payment model.”

In order to turn the corner on telehealth reimbursement for home health, the only feasible route advocates can take is through Congress. From there, a demo program would have to be created by the Center for Medicare & Medicaid Innovation (CMMI).

Another potential roadblock, however, is that  telehealth has been abused during the pandemic. Not necessarily by home health providers – it would be hard to abuse it without corresponding pay – but instead by other health care providers across the continuum. 

“The caution light is going off in Washington relative to…