Medicare Trustees Warn of Long-term Financing Problems

The recently-released Medicare trustees annual report on the state of the Medicare program currently projects sufficient funds into 2028, two years longer than last year’s estimate. At that point revenues would be able to cover 90 percent of Medicare outlays.

The Medicare Part A program is funded by the Hospital Insurance (HI) trust fund, by way of payroll taxes.

Despite the extended solvency, the trustees warned of long-term financing challenges stating. “Social Security and Medicare both face long-term financing shortfalls under currently scheduled benefits and financing,” wrote the trustees, adding that “current-law projections indicate that Medicare still faces a substantial financial shortfall that will need to be addressed with further legislation. Such legislation should be enacted sooner rather than later to minimize the impact on beneficiaries, providers, and taxpayers.”

As expected, COVID-19 had significant impact on the short-term financing of Medicare, but at this time the trustees do not expect it to hold negative long-term ramifications, likely attributable to vaccine and treatment availability.

For 2021 totals Medicare provided coverage for nearly 64 million people, 55.5 million of who are 65 or older and 8.3 million who are disabled.

Medicare Trustees Warn of Long-term Financing Problems

The recently-released Medicare trustees annual report on the state of the Medicare program currently projects sufficient funds into 2028, two years longer than last year’s estimate. At that point revenues would be able to cover 90 percent of Medicare outlays. The Medicare Part A program is funded by the Hospital Insurance (HI) trust fund, by way of…

OIG Workplan to Include OASIS Falls Reporting & Post-acute Transfer Policy

The Department of Health & Human Services Office of the Inspector General (OIG) reported the addition of a new study and a new audit that should be of interest to the home health and hospice communities. These alerts to the public via daily updates of new audits and reports is part of the OIG Work Plan. The…

Choose Home Care Act Picks Up Sponsors in Congress

  • Click Here to Urge Congress to support the Choose Home Care Act!

The Choose Home Care Act continues to build support in Congress with the recent addition of three new cosponsors in the House of Representatives. Reps. Lisa Blunt Rochester (D-DE), John Moolenaar (R-MI), and James McGovern (D-MA) have joined 33 of their colleagues in the House in supporting the legislation.

We thank the new sponsors of this legislation for their leadership on this issue.

The Choose Home Care Act seeks to provide an option to patients in where they receive their post-acute care upon discharge from a hospital within the Medicare program. If deemed a good fit by the hospital and home health agency for the Choose Home model, a patient could elect to continue their recovery at home with enhanced services and supports added onto the traditional home health benefit. The added services could include personal care services, meal delivery, and respite care, among several others.

The Choose Home Act is a top legislative priority for NAHC. In addition, other supporting organizations include AARP, the Partnership for Quality Home Health Healthcare (PQHH), LeadingAge, the National Council on Aging (NCOA), the Moving Health Home Coalition and others.

Imminent legislative activity is not expected as attention will shift towards reelection campaigns during the summer and early fall. In the meantime, NAHC will continue to build knowledge of the legislation on Capitol Hill, as well as add new supporters to optimize the Choose Home Care Act‘s chances of coming up for a vote.

NAHC encourages all members and home care professionals to urge their Senators and Representatives to support the bill. This can easily be done through the NAHC Legislative Action Center here.

Choose Home Care Act Picks Up Sponsors in Congress

Click Here to Urge Congress to support the Choose Home Care Act! The Choose Home Care Act continues to build support in Congress with the recent addition of three new cosponsors in the House of Representatives. Reps. Lisa Blunt Rochester (D-DE), John Moolenaar (R-MI), and James McGovern (D-MA) have joined 33 of their colleagues in…

CMS’ Requirements for NPs Ordering Home Health Services Raises Concern

NAHC has major concerns it will be addressing with CMS On April 27, 2022, the Centers for Medicare & Medicaid Services (CMS) issued Change Request 12615 to clarify requirements for allowed practitioners under the home health benefit. In the “Background” section of the transmittal, CMS states that nurse practitioners and clinical nurse specialists acting as…

Sequestration Resumes for Medicare Providers

The Protecting Medicare and American Farmers from Sequester Cuts Act impacts payments for all Medicare fee-for-service claims. As a result of this Act, a suspension on the sequestration was put in place due to the COVID-19 public health emergency (PHE.) The sequestration was suspended through March 31, 2022.

Effective April 1, 2022, the one percent sequestration payment adjustment will be applied for claims with dates of services from April 1, 2022 to June 30, 2022.

Of note, the sequestration payment adjustment will revert to the two percent rate for claims with dates of services as of July 1, 2022. This will bring the total sequestration rate to two percent, which was the rate in effect prior to the PHE.

For home health providers, the adjustment applies to the respective “through” date on the claim.

The sequestration payment adjustment decrease will appear on the RA with a CARC 253, used to report the sequestration reduction. The code will appear as a CO 253 on the RA “Sequestration – reduction in federal payment” as the reason.

Sequestration Resumes for Medicare Providers

The Protecting Medicare and American Farmers from Sequester Cuts Act impacts payments for all Medicare fee-for-service claims. As a result of this Act, a suspension on the sequestration was put in place due to the COVID-19 public health emergency (PHE.) The sequestration was suspended through March 31, 2022. Effective April 1, 2022, the one percent sequestration…

OIG Finds Inappropriate Service Denials by MAOs

An Office of Inspector General (OIG) report determined that Medicare Advantage Organizations (MAOs) sometimes delayed or denied Medicare Advantage beneficiaries’ access to services, even though the requests met Medicare coverage rules. MAOs also denied payments to providers for some services that met both Medicare coverage rules and MAO billing rules. In the report, Some Medicare Advantage Organization Denials…

Bipartisan Push in Congress to Make Medicare Enrollment Easier

Legislation has recently been introduced that would work to improve the Medicare enrollment process for individuals nearing Medicare eligibility, aged 60-64. Longtime home care champions Senators Bob Casey (D-PA) and Todd Young (R-IN) are leading the charge for the Beneficiary Enrollment Notification and Eligibility Simplification 2.0 (BENES 2.0) Act, (S. 2675). BENES 2.0 continues the theme of the original BENES Act, many provisions of which became law in the Consolidated Appropriations Act of 2021, in supporting individuals in their Medicare enrollment process.

BENES 2.0 would require the federal government to provide clear explanation on Medicare benefit eligibility, information on late enrollment penalties, coordination of benefits, and resources available for further assistance. This information is to be included on Social Security Account statements for those attaining the ages of 60 – 65.

At introduction Senator Casey stated, “Medicare is one of America’s greatest success stories, but we need to make sure people can make the most of the Medicare benefits they have earned. That’s why I introduced the bipartisan BENES 2.0 Act to ensure that fewer people miss the deadline to enroll, which can lead to costly lifelong penalties.”

Senator Young added, “Currently, seniors who miss the sign-up deadline for Medicare Part B face onerous penalties that persist for the rest of their lives. The BENES 2.0 Act will ensure individuals have access to the information necessary to make more informed decisions as they approach Medicare eligibility.”

Joining Senator Casey and Young with introduction were Senators Debbie Stabenow (D-MI), Susan Collins (R-ME), Kyrsten Sinema (D-AZ), Tim Scott (R-SC), Sherrod Brown (D-OH) and Tina Smith (D-MN).