Medicare Home Health Care: Prospective Payment System Could Reverse Recent Declines in Spending
HEHS-00-176
Published: Sep 08, 2000. Publicly Released: Sep 08, 2000.
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Highlights
Pursuant to a congressional request, GAO provided information on Medicare home health care's recent declines in spending, focusing on: (1) the declines in service use underlying the changes in spending; (2) the extent of the changes in use across beneficiaries, home health agencies (HHA), and locations; and (3) identify any implications these new patterns of home health use have for the impact of the prospective payment system (PPS).
Recommendations
Matter for Congressional Consideration
| Matter | Status | Comments |
|---|---|---|
| Given the uncertainties for beneficiaries, HHAs, and the Medicare program associated with the home health agency PPS, Congress may wish to consider requiring the Health Care Financing Administration (HCFA) to implement a risk-sharing arrangement under the PPS to moderate excessive HHA gains or losses as soon as practicable. GAO believes that a risk-sharing arrangement would offer protection to Medicare beneficiaries, home health agencies, and the Medicare program from any unintended consequences of the home health PPS. | Congress has not required the Centers for Medicare and Medicaid Services to implement a risk-sharing arrangement, and the agency has not pursued the issue. No action is expected. |
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Topics
Claims processingHealth care cost controlHealth insuranceHealth resources utilizationHome health care servicesInternal controlsMedical services ratesMedicareProspective paymentsProgram beneficiaries