Access to Medicare home health, SNF eased

In the midst of the vague insanity that is the last two week of a Presidential campaign, Medicare has announced a consequential policy change that will expand access to Medicare-financed home health visits and skilled nursing facility (SNF) care for beneficiaries with disabilities.

Currently, such care is limited to cases in which a patient’s condition is believed to potentially improve, often via the delivery of rehabilitative services whether in the SNF or home setting. The new rules come from the settlement of a lawsuit brought on behalf of disabled persons. The key change is:

Medicare will pay for such services if they are needed to “maintain the patient’s current condition or prevent or slow further deterioration,” regardless of whether the patient’s condition is expected to improve.

This is part of a larger story of a country without a coherent long term care system. Families care for loved ones as best they can at great financial and non financial costs (there are also benefits), and Medicaid serves as the de facto nursing home insurance scheme for the nation (about half of all nursing home costs are paid for by Medicaid).

Medicare, the insurer of persons age 65 and older, has an unusual place in this story. Many seniors wrongly believe that it covers long term care generally, and care for a long-stay nursing home, specifically. And recent Medicare policy has exacerbated this gap between reality and what is needed by beneficiaries. In the 1990s, Medicare home health rules were tightened by adding the requirement related to improvement, that is now being reversed. This was done to limit costs and allay fears fears that home health would morph into a long term care benefit. Similarly, discussions framing long stays in hospice as problems, while ignoring short stays (which likely suggest quality issues and/or not maximizing benefits) also demonstrate the institutional worry (by Medicare) about a part(s) of the program becoming a de facto long term care benefit.

Much work is needed to develop a coherent long term care system that works along side (and with) the acute care system.