Home care industry touts bipartisan bill to expand Medicare in-home benefits, reimbursement

Healthcare providers and tech companies with a stake in home health have coalesced around bipartisan legislation introduced last week that would shift care away from the hospital to patients' living rooms and bedrooms.

The Expanding Care in the Home Act sponsored by Reps. Adrian Smith, R-Nebraska, and Debbie Dingell, D-Michigan, would expand access to and reimbursement for various home care services delivered to Medicare beneficiaries. The bill proposes a baseline 12 hours per week of personal care services benefit in Medicare, which advocates say would help support a population of beneficiaries unable to afford out-of-pocket home care but not quite poor enough to qualify under Medicaid.

“As we identify opportunities to modernize the care seniors can access, we must consider the convenience and comfort home care offers them,” Smith said in a release. “The Expanding Care in the Home Act is a commonsense measure to ensure Medicare can process claims for in-home care services, and I’m proud to lead introduction of this important bill.”

Additionally, reimbursement funds and policy adjustments directed by the tentative legislation would open the door for primary care house calls; increase access to home dialysis, in-home advanced diagnostic, in-home lab testing and home infusion services; and help support the development of additional home-based care workers, according to a release.

“We know people often prefer to receive care in the comfort and security of their own homes, and the COVID-19 pandemic highlighted the importance of expanding access to health care beyond traditional doctor’s office or hospital settings,” Dingell said in a release. “I’m proud to introduce this legislation which will help remove barriers to care and increase options for patients to receive critical care in the setting of their choice.”

The proposed bill is being championed by Moving Health Home, an advocacy group comprised of DaVita Kidney Care, Ascension, Amazon, Signify Health, Current Health, Intermountain Healthcare and at least 15 other stakeholder industry groups, according to its website.

The group said patients and constituents support increased access to clinical care at home, citing 2021 survey data showing support for such expansions among adults from both major political parties.

Many home health services—particularly those enabled by technologies such as remote monitoring—had seen a boost during the pandemic due to a combination of regulatory waivers and inpatient capacity concerns.

“The pandemic has taught us, and polls confirm, that care in the home is preferred by many patients, with increasing demand for at-home options,” Krista Drobac, founder of Moving Health Home, said in a press release. “Not only do home-based models increase access to care in general, they have also demonstrated the ability to successfully reduce costs, improve quality and outcomes, maintain safety comparable to or better than facilities, and address disparities.”

Members of the coalition also said that expanding these services could be a cost-effective way for Medicare to prevent hospitalizations at scale, a major focus for lawmakers amid spending debates and concerns that Medicare could run out of money within the next decade.

“When we look at improvements in clinical outcomes and cost savings of established care-at-home programs, there is a clear value proposition and positive return on investment, which is driving a healthcare revolution at home,” Maulik Majmudar, M.D., chief medical officer and co-founder of Moving Health Home member Biofourmis, said in a release.

“This bill will help facilitate the shift to new care delivery models that we know can move healthcare forward by driving better patient outcomes and lower costs at scale,” Chris McCann, CEO and co-founder of Current Health, another Moving Health Home member, said in a statement.

Supplemental benefits aimed at in-home services are on the rise among Medicare Advantage plans, per a late 2022 report conducted by Milliman on behalf of the Better Medicare Alliance.

Additionally, a McKinsey report from early 2022 estimates that as much as $265 million in Medicare fee-for-service and Medicare Advantage care spending could shift to the home by 2025.

“Medicare Advantage plans have seen the value of help in the home, and [we believe] the time has come to make this benefit accessible to all Medicare beneficiaries,” Right at Home, another member of Moving Health Home, said in its own press release applauding the proposed legislation.