The Senate Finance Committee’s Subcommittee on Health Care held a hearing Tuesday regarding aging in place and access to home health care in the U.S. 

While current struggles were highlighted throughout, the hearing was ultimately a symbolic win for home health providers across the country.

Lawmakers came across as more educated on home health care – and the issues the sector faces – than ever. They also, generally, seemed to be unsure why more investment wasn’t being put toward home-based care.

“Because of the lack of a coordinated policy, seniors often end up in a more costly environment, in a less desirable environment, and – I would suggest – a more dangerous environment for their long-term health,” Sen. Ben Cardin (D-MA), the chair of the subcommittee, said.

Cardin also began the hearing by mentioning there’s a “great deal of interest” from both Democrats and Republicans on the topic of home health care.

The hearing was “very well attended,” according to Partnership for Quality Home Healthcare CEO Joanne Cunningham.

The chair of the Senate Finance Committee, Ron Wyden, was also there, for instance.

Witnesses for the hearing included: William A. Dombi, the president of the National Association for Home Care & Hospice; Carrie Edwards, the director of home care services at Mary Lanning Healthcare; Judith Stein, the executive director of the Center for Medicare Advocacy; and David Grabowski, a professor and researcher at Harvard Medical School.

“I think the big message was very clearly that the Senate Finance Committee, on a bipartisan basis, cares a lot about the Medicare home health program, and is concerned about reimbursement cuts and the impact that workforce shortages are having on access to care,” Cunningham told Home Health Care News.

The overarching theme was, of course, the Centers for Medicare & Medicaid Services’ (CMS) home health payment cuts.

Witnesses were able to openly discuss the impact that cuts have had up to this point, and the impact further cuts would have in the future.

They were also able to discuss the dangers of skyrocketing referral rejection rates, the impact of further Medicare Advantage (MA) penetration and the issues the provider community takes with Medicare Payment Advisory Commission’s (MedPAC) reports on home health care.

“It is overall financial margins that really measure financial stability, not the incomplete analysis presented by MedPAC,” Dombi said during the hearing. “Medicare margins – to the extent they exist – are subsidizing other payers like Medicaid and Medicare Advantage.”

Sens. Steve Daines (R-MT), Ron Wyden (D-OR), Debbie Stabenow (D-MI) and Tom Carper (D-DE), among others, also participated in the hearing.

“I would also suggest that the reimbursement structure has added to the challenges for people being able to get the home health care that they need,” Cardin said.

Access to home health care

The great news for providers is that lawmakers in the well-attended hearing were making similar points to those of their own.

“I’ve always thought that this was a pretty straightforward proposition,” Wyden said. “When people ask about the costs of designing home health care services, I always say … you can’t afford to pass up this kind of option – giving people more of what they want at less cost to taxpayers.”

There was little pushback in the hearing, and CMS’ and MedPAC’s views on home health care or home health cuts were not represented.

“Every member of the Senate who spoke was very much in full understanding of what the program does for Medicare beneficiaries, and also, the enormity of the challenges facing the Medicare home health program,” Cunningham said.

When a hearing is held on a specific topic like home health care, it typically means there is some deal of concern from lawmakers on that topic or area.

Thursday’s hearing could trigger multiple next steps, but it’s unclear what those next steps could be at this point.

“I thought today’s hearing sent a very strong signal that that the the Medicare home health Program is really important to the Senate Finance Committee, and to Congress, and that Congress intends to take a look at policy solutions that would address some of the issues that they raised,” Cunningham said.

The home health provider voice – Carrie Edwards – painted the picture of worsening home health access from her company’s perspective.

“Our ability to deliver patient-preferred, high-quality, cost-effective and life-saving home health services is in jeopardy, and not due to any service failures of Mary Lanning Healthcare, but rather, because of decisions being made right now by CMS that threaten my home health agency and thousands of other agencies across the country,” Edwards said during the hearing.

Based in Hastings, Nebraska, Mary Lanning Healthcare is a hospital-based, nonprofit provider of a wide array of home-based care services.

The company’s home health arm previously covered a 13-county, 60-mile radius. In March, it had to reduce its service area to a 40-mile radius due to home health cuts. In May, it had to reduce its service area to just cover a 25-mile radius, leaving some counties without coverage from another home health provider, Edwards said.

This year, Mary Lanning Healthcare has declined 50% of its referrals.

“Our average daily census count reduced by more than 60% since the implementation of the new payment model, from an average of 88 patients in 2022 to a census count in September 2023 of 32,” Edwards said. “CMS’ actions are also having a direct impact on our ability to retain our existing workforce. We’ve had three registered nurses resign due to fear that the looming payment cuts being proposed by CMS will force our agency to close.”

She added that her agency has a five-star patient satisfaction score and has prevented over 93% of patients from being readmitted to the hospital, which is better than average on both the state and national level.

“We’re doing everything possible to remain operational,” Edwards said. “There are agencies throughout Nebraska and the country that are at serious risk of closure. If I can leave the committee with one takeaway from my testimony today, it’s that CMS and policymakers should be finding every way possible to make increased investments in Medicare home health services, instead of the current path of year-after-year payment cuts that are jeopardizing my agency’s ability to care for Medicare beneficiaries.”

Alternative views on the sector

Judith Stein, the executive director of the Center for Medicare Advocacy, made it clear that an overhaul of the Medicare home health benefit was not necessarily needed.

Instead, it just has to be enforced and utilized as it already exists.

“My main message today is simple – to enforce the law that already exists,” Stein said. “Currently, this is not the case. Instead, Medicare home health coverage is incorrectly understood and implemented as a short-term acute care benefit by those who administer the Medicare program, home health providers and those who make Medicare coverage decisions.”

When properly implemented, the home health benefit provides coverage for a “constellation of skilled and non-skilled services, all of which add to the health, safety and quality of life of beneficiaries and their families,” she added.

Both lawmakers and witnesses also took issue with MedPAC’s definition of adequate access to home health care. MedPAC looks at how many health agencies are active in a given zip code to determine whether home health access is sufficient.

But even if there are active agencies near a beneficiary’s home, that doesn’t mean they’ll seamlessly be able to receive home health services. As Edwards laid out, agencies have staffing constraints and are often unable to accept new referrals.

Dombi also brought up MA plans, how they pay less for home health services and how that distorts overall margins for agencies across the country.

He ended with a plea for Congress to pass the Preserving Access to Home Health Act, which would mitigate home health cuts and also force MedPAC to take a more holistic view of the sector.

“You can tell by the number of members here and their participation that this is an area of great interest to this committee,” Cardin said. “We understand the importance of home health care. And we recognize that we have not achieved the level [of it] that we need for our country, or expect.”