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Copay may be tacked on to Medicare home health visits

| Friday, Jan. 14, 2011

WASHINGTON -- Medicare recipients could experience a sizable new out-of-pocket charge for home health visits if Congress follows through on a recommendation issued yesterday by its advisory panel.

Until now, home health visits from nurses and other providers have been free of charge to patients. But the Medicare Payment Advisory Commission says a copayment is needed to discourage overuse of a service whose cost to taxpayers is nearing $20 billion a year amid concerns that fraudsters are taking advantage.

The panel did not prescribe an amount, but its staff has suggested the charge be $150 for a series of related visits. Medicare requires copays for many services, so home health has been the exception, not the rule.

Defying opposition by AARP, the seniors' lobby, the congressionally appointed commission voted 13-1 to recommend that lawmakers impose the new charge. Two commissioners abstained and one was absent.

"At the extreme, this benefit can turn into a long-term care social support system," said commission chairman Glenn Hackbarth. "A modest copayment is one tool to help deal with that problem."

The advice was given as lawmakers face a tough budget year. A sluggish economy and tax cuts are draining revenue while deficits soar to ranges widely seen as unsustainable. Republicans won control of the House on a promise to curb spending, yet there's little hope of that unless Congress and the president can agree on ways to restrain health care costs.

More than 3 million seniors and disabled people on Medicare use home health services -- visits from nurses, personal care attendants and therapists, available to those who can't easily get out of the house.

Home health once was seen as a cost saver, since it's clearly cheaper than admitting patients to the hospital. But it's been flagged as a budget problem because of rapidly increasing costs and big differences in how communities use the benefit.

Part of the problem appears to be rampant fraud. In some counties, home health admissions exceed the number of residents on Medicare.

Several commissioners said they worry about the impact of a new charge on seniors with modest incomes. Numerous studies have shown that even small copayments can discourage patients from getting medical services.

The charge would be collected for each home health agency admission, not for every visit by a nurse or provider. Patients can be under home health care for weeks at a time.

The recommendation exempts low-income patients, whose copayments would be covered by Medicaid, as well as those just discharged from the hospital. More than 30 million beneficiaries in traditional Medicare would be directly subject to the fee. Repercussions for seniors in private Medicare Advantage plans are uncertain.

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