Headline

Contains policy recommendations to improve the home health care benefit for people on Medicare with complex needs.

Context

Traditional home health services, including skilled nursing, rehabilitative therapies, home health aide services, and medical social services, are a Medicare benefit for individuals who need skilled care for short periods of time but are unable to leave home to receive it. As designed, however, the Medicare home health benefit has limited capacity to support individuals with complex health conditions. This report shares policy recommendations to improve care for Medicare beneficiaries with chronic illness and reduce racial and ethnic disparities.

Findings

Recommendations include:

• Streamlining coverage and eligibility determinations to improve administration of the Medicare home health benefit and prevent unwarranted coverage denials;
• Adjusting quality and payment incentives to reward whole-person care;
• Optimizing service availability for beneficiaries by appropriate care team members; and
• Improving the experience of beneficiaries and caregivers.

These policies can be adopted under the current regulatory framework using existing Centers for Medicare & Medicaid Services authorities.

Takeaways

Policymakers should consider these recommendations to improve the current payment structure of the Medicare home health benefit and improve the delivery of care for individuals with complex health needs.