Although Congressional support continues to grow for the Choose Home Care Act of 2021 in Washington, D.C., the legislation remains in limbo.
Other pieces of legislation for lawmakers have pushed the Choose Home bill down the priority list, but National Association for Home Care & Hospice (NAHC) President William A. Dombi is hopeful something will come of it soon.
“Priorities in Washington became politics,” Dombi told Home Health Care News last week at the Capital+Strategy conference. “The amount of air in Washington to deal with new things kept disappearing.”
Choose Home — among other things — supports in-home care alternatives to skilled nursing facilities (SNFs). If enacted, the legislation would enable certain Medicare patients to receive extended care services as an add-on to the existing Medicare home health benefit for 30 days following a hospital stay.
In addition to receiving skilled nursing or rehabilitation services from their home health provider, for example, a patient could potentially receive meals, non-emergency transportation, remote patient monitoring and more.
The idea is to give today’s highly diversified in-home care providers more flexibility and financial support to keep at-risk Medicare beneficiaries at home and out of costlier facility-based settings, in turn saving the U.S. health care system hundreds of millions of dollars a year.
Endorsed by the AARP and supported by a long list of home-based care advocates, Choose Home started gaining momentum on Capitol Hill early in 2021.
Now that Congress is through the budget and the U.S. government is trying to figure out how to properly aid and assist Ukraine, there should be time for Choose Home in political schedules, Dombi said.
“Our support continues to grow,” he said. “We got more co-sponsors last week, but where we are is, in one respect, where we were three months ago.”
In order for legislation like Choose Home to move forward, the Congressional Budget Office (CBO) has to tell Congress how much a proposed piece of legislation will cost or save. In today’s political climate, Dombi said, if a piece of legislation is going to cost, you’ve got to find some way to pay for it.
It’s like taking money from a cousin to give it to a nephew, Dombi explained. The money would still remain in the same sphere, just in different buckets.
“What we’re arguing — and we think we’re well founded in that — is providing the option of care at home with more resources will avoid nursing home stays, which costs more,” he said.
With that reasoning, Choose Home will save money. However, at the end of the day, the CBO will make that determination.
“The speed bump we’re at right now is getting CBO to give the score,” he said. “We have a number of parties waiting in the wings to move it forward in the event that the score comes out at a level that’s manageable.”
NAHC and other organizations are also preparing right now for a score to come out that says Choose Home will cost. It’s their mission to find ways to pay for it that will convince lawmakers to pass the bill.
NAHC, LeadingAge, Allies for Independence and Moving Health Home – the relatively new home care coalition whose founding members include Amazon Care and multiple health systems – are among other organizations behind Choose Home. The National Council on Aging, the Council of State Home Care & Hospice Associations and the Forum of State Associations, a division of NAHC, support the bill as well.
However, one of the industries that does not support Choose Home is the SNF industry.
SNFs have multiple reimbursement or revenue streams, similar to home health agencies. There are Medicaid, Medicare and also private-pay dollars.
Generally, Medicare and private-pay offers greater margins compared to Medicaid.
“Given the margins are so tiny for nursing homes, in an aggregate sense, they’re looking to protect their business interests,” Dombi said. “We’re not trying to kick them when they’re down. This concept of Choose Home was on our platform 25 years ago.”
If it makes it out of Congress, Choose Home would generate an estimated $247 million in annual savings to the Medicare system, with the majority of that coming from reduced SNF utilization, a Dobson DaVanzo & Associates analysis found.
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