Bill Overview
Title: Preserving Access to Home Health Act of 2022
Description: This bill restricts the Centers for Medicare & Medicaid Services (CMS) from decreasing payments for Medicare home health services based on certain adjustments until 2026. Current law requires the CMS to make certain permanent and temporary payment adjustments under the Medicare prospective payment system for home health services based on behavioral assumptions for 2020 through 2026. The bill restricts the CMS from making adjustments that decrease payments until 2026; the CMS must also ensure that any such necessary decreases are made before 2032.
Sponsors: Sen. Stabenow, Debbie [D-MI]
Target Audience
Population: Individuals utilizing Medicare home health services
Estimated Size: 58000000
- Home health services are primarily utilized by elderly individuals and those with disabilities who require medical treatment or assistance at home.
- Medicare is a federal program in the United States, suggesting that the impacted population will largely consist of U.S. citizens on or eligible for Medicare.
- The restriction on CMS decreasing home health service payments aims to ensure continued access for Medicare beneficiaries.
- Given the federal nature of Medicare, the global impact is largely limited to the U.S., although there may be indirect global interest in the approach being taken by a major healthcare system.
Reasoning
- The policy primarily affects elderly individuals and those with disabilities who depend on Medicare home health services. We need to consider different geographical and socio-economic contexts because these factors influence how individuals interact with the health service system.
- The budget constraint of $1 billion in the first year and $10 billion over 10 years suggests that the policy needs to be cost-effective. The policy aims to prevent payment reductions, which might initially increase the budget due to maintaining the current payment levels.
- Approximately 58 million Medicare beneficiaries could potentially be impacted by this policy, but not all of them use home health services. We'll focus on those who do, which is a smaller subset.
- We'll include individuals who are not directly affected to simulate a realistic distribution.
- We use Cantril Wellbeing Scale ranging from 0 to 10 to evaluate current and future wellbeing. The policy's impact will be assessed by changing well-being scores over different years under the two scenarios.
Simulated Interviews
Retired teacher (Florida)
Age: 72 | Gender: female
Wellbeing Before Policy: 5
Duration of Impact: 10.0 years
Commonness: 8/20
Statement of Opinion:
- The policy sounds like it will be beneficial for people like me. I rely heavily on home health services and any reduction in support would be challenging.
Wellbeing Over Time (With vs Without Policy)
| Year | With Policy | Without Policy |
|---|---|---|
| Year 1 | 6 | 4 |
| Year 2 | 6 | 4 |
| Year 3 | 7 | 3 |
| Year 5 | 7 | 3 |
| Year 10 | 8 | 2 |
| Year 20 | 6 | 2 |
Retired engineer (California)
Age: 66 | Gender: male
Wellbeing Before Policy: 6
Duration of Impact: 10.0 years
Commonness: 6/20
Statement of Opinion:
- It’s crucial to maintain the level of care I receive at home. Any cuts would significantly affect my ability to live independently.
Wellbeing Over Time (With vs Without Policy)
| Year | With Policy | Without Policy |
|---|---|---|
| Year 1 | 7 | 5 |
| Year 2 | 7 | 4 |
| Year 3 | 8 | 4 |
| Year 5 | 8 | 3 |
| Year 10 | 7 | 3 |
| Year 20 | 7 | 3 |
Retired nurse (New York)
Age: 85 | Gender: female
Wellbeing Before Policy: 6
Duration of Impact: 10.0 years
Commonness: 7/20
Statement of Opinion:
- Any policy that supports home health services is welcome. I need these services both for health and comfort.
Wellbeing Over Time (With vs Without Policy)
| Year | With Policy | Without Policy |
|---|---|---|
| Year 1 | 7 | 5 |
| Year 2 | 7 | 5 |
| Year 3 | 7 | 4 |
| Year 5 | 8 | 4 |
| Year 10 | 9 | 3 |
| Year 20 | 8 | 3 |
Self-employed, part-time (Texas)
Age: 64 | Gender: male
Wellbeing Before Policy: 5
Duration of Impact: 10.0 years
Commonness: 5/20
Statement of Opinion:
- Maintaining current payment levels will support our household budget, as we need reliable home health care.
Wellbeing Over Time (With vs Without Policy)
| Year | With Policy | Without Policy |
|---|---|---|
| Year 1 | 6 | 4 |
| Year 2 | 6 | 4 |
| Year 3 | 7 | 3 |
| Year 5 | 6 | 2 |
| Year 10 | 7 | 2 |
| Year 20 | 6 | 2 |
Retired factory worker (Ohio)
Age: 90 | Gender: female
Wellbeing Before Policy: 4
Duration of Impact: 10.0 years
Commonness: 6/20
Statement of Opinion:
- It's difficult to understand policy details, but if it helps keep my services, I'm for it.
Wellbeing Over Time (With vs Without Policy)
| Year | With Policy | Without Policy |
|---|---|---|
| Year 1 | 5 | 3 |
| Year 2 | 5 | 3 |
| Year 3 | 5 | 3 |
| Year 5 | 6 | 2 |
| Year 10 | 6 | 2 |
| Year 20 | 5 | 1 |
Retired steelworker (Michigan)
Age: 78 | Gender: male
Wellbeing Before Policy: 5
Duration of Impact: 5.0 years
Commonness: 4/20
Statement of Opinion:
- Without steady support, it might be difficult to continue my recovery at home.
Wellbeing Over Time (With vs Without Policy)
| Year | With Policy | Without Policy |
|---|---|---|
| Year 1 | 6 | 4 |
| Year 2 | 7 | 3 |
| Year 3 | 7 | 3 |
| Year 5 | 8 | 2 |
| Year 10 | 6 | 2 |
| Year 20 | 5 | 2 |
Part-time teacher (Mississippi)
Age: 52 | Gender: female
Wellbeing Before Policy: 7
Duration of Impact: 10.0 years
Commonness: 10/20
Statement of Opinion:
- While it doesn't directly affect me, my parents rely on these services, so maintaining them is essential.
Wellbeing Over Time (With vs Without Policy)
| Year | With Policy | Without Policy |
|---|---|---|
| Year 1 | 7 | 7 |
| Year 2 | 7 | 6 |
| Year 3 | 7 | 6 |
| Year 5 | 7 | 5 |
| Year 10 | 7 | 5 |
| Year 20 | 7 | 4 |
Retired pharmacist (Arizona)
Age: 68 | Gender: male
Wellbeing Before Policy: 8
Duration of Impact: 0.0 years
Commonness: 12/20
Statement of Opinion:
- I support the policy as it protects vulnerable populations even if it doesn't impact me directly.
Wellbeing Over Time (With vs Without Policy)
| Year | With Policy | Without Policy |
|---|---|---|
| Year 1 | 8 | 8 |
| Year 2 | 8 | 8 |
| Year 3 | 8 | 8 |
| Year 5 | 8 | 8 |
| Year 10 | 8 | 8 |
| Year 20 | 8 | 7 |
Retired librarian (Georgia)
Age: 74 | Gender: female
Wellbeing Before Policy: 6
Duration of Impact: 6.0 years
Commonness: 6/20
Statement of Opinion:
- It's reassuring that services won't be reduced; they are lifesavers when I need them.
Wellbeing Over Time (With vs Without Policy)
| Year | With Policy | Without Policy |
|---|---|---|
| Year 1 | 6 | 5 |
| Year 2 | 7 | 5 |
| Year 3 | 7 | 4 |
| Year 5 | 7 | 3 |
| Year 10 | 6 | 2 |
| Year 20 | 5 | 1 |
Retired accountant (Illinois)
Age: 70 | Gender: male
Wellbeing Before Policy: 5
Duration of Impact: 10.0 years
Commonness: 5/20
Statement of Opinion:
- Medicare payments stability will help me manage my health conditions without fear of increased personal costs.
Wellbeing Over Time (With vs Without Policy)
| Year | With Policy | Without Policy |
|---|---|---|
| Year 1 | 6 | 4 |
| Year 2 | 7 | 4 |
| Year 3 | 7 | 3 |
| Year 5 | 8 | 2 |
| Year 10 | 7 | 2 |
| Year 20 | 7 | 1 |
Cost Estimates
Year 1: $1000000000 (Low: $900000000, High: $1100000000)
Year 2: $1000000000 (Low: $900000000, High: $1100000000)
Year 3: $1000000000 (Low: $900000000, High: $1100000000)
Year 5: $1000000000 (Low: $900000000, High: $1100000000)
Year 10: $1000000000 (Low: $900000000, High: $1100000000)
Year 100: $1000000000 (Low: $900000000, High: $1100000000)
Key Considerations
- The policy prevents CMS from applying planned behavioral adjustments, potentially leading to increased expenditures.
- Maintaining payment levels could discourage efficiency improvements generally enforced by cost-reduction adjustments.
- Impacts largely focus on maintaining access to home health care for Medicare recipients.