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entitled 'Medicare: Utilization of Home Health Care by State' which 
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GAO-02-782R: 

United States General Accounting Office: 
Washington, DC 20548: 

May 23, 2002: 

The Honorable Henry A. Waxman: 
Ranking Minority Member:
Committee on Government Reform: 
House of Representatives: 

Subject: Medicare: Utilization of Home Health Care by State: 

Dear Mr. Waxman: 

This letter responds to your request for information on the variation 
in Medicare home health use across states. Using home health claims 
for the first 6 months of 2001 from the Centers for Medicare and 
Medicaid Services (CMS), we compiled statistics on home health users, 
home health visits, home health episodes, and the percentage of home 
health users with multiple episodes for each state. This information 
is included in enclosure I. A home health episode, the basis for 
Medicare payment under the prospective payment system, is up to a 60- 
day period of care during which any number of visits may be provided. 
We performed our work in May of 2002, in accordance with generally 
accepted government auditing standards. (See enclosure II for a 
description of our scope and methodology.) 

As arranged with your office, unless you release its contents earlier, 
we plan no further distribution of this letter until 30 days after its 
issuance date. At that time, we will send copies to interested 
parties. This letter will also be available at no charge on GAO's home 
page at [hyperlink, http://www.gao.gov]. If you or your staff have any 
questions regarding this letter, please contact me at (202) 512-7119 
or James E. Mathews at (202) 512-9427. 

Sincerely yours, 

Signed by: 

Laura A. Dummit: 
Director, Health Care  Medicare Payment Issues: 

Enclosures  2: 

[End of letter] 

Enclosure I: Medicare Home Health Utilization, January-June 2001: 

Table 1: Medicare Home Health Users, by State: 

State: Alabama; 
Users per 1,000 beneficiaries[A,B]: 39; 
Visits per user[A]: 30; 
Visits per episode: 20.15. 

State: Alaska; 
Users per 1,000 beneficiaries[A,B]: 20; 
Visits per user[A]: 17; 
Visits per episode: 13.98. 

State: Arizona; 
Users per 1,000 beneficiaries[A,B]: 22; 
Visits per user[A]: 18; 
Visits per episode: 15.02. 

State: Arkansas; 
Users per 1,000 beneficiaries[A,B]: 35; 
Visits per user[A]: 28; 
Visits per episode: 19.02. 

State: California; 
Users per 1,000 beneficiaries[A,B]: 38; 
Visits per user[A]: 22; 
Visits per episode: 16.67. 

State: Colorado; 
Users per 1,000 beneficiaries[A,B]: 33; 
Visits per user[A]: 23; 
Visits per episode: 17.87. 

State: Connecticut; 
Users per 1,000 beneficiaries[A,B]: 46; 
Visits per user[A]: 29; 
Visits per episode: 22.25. 

State: Delaware; 
Users per 1,000 beneficiaries[A,B]: 34; 
Visits per user[A]: 24; 
Visits per episode: 18.98. 

State: District of Columbia; 
Users per 1,000 beneficiaries[A,B]: 30; 
Visits per user[A]: 23; 
Visits per episode: 18.70. 

State: Florida; 
Users per 1,000 beneficiaries[A,B]: 44; 
Visits per user[A]: 26; 
Visits per episode: 20.27. 

State: Georgia; 
Users per 1,000 beneficiaries[A,B]: 34; 
Visits per user[A]: 28; 
Visits per episode: 19.84. 

State: Hawaii; 
Users per 1,000 beneficiaries[A,B]: 16; 
Visits per user[A]: 17; 
Visits per episode: 14.48. 

State: Idaho; 
Users per 1,000 beneficiaries[A,B]: 30; 
Visits per user[A]: 21; 
Visits per episode: 16.21. 

State: Illinois; 
Users per 1,000 beneficiaries[A,B]: 38; 
Visits per user[A]: 21; 
Visits per episode: 15.95. 

State: Indiana; 
Users per 1,000 beneficiaries[A,B]: 28; 
Visits per user[A]: 24; 
Visits per episode: 18.22. 

State: Iowa; 
Users per 1,000 beneficiaries[A,B]: 24; 
Visits per user[A]: 21; 
Visits per episode: 16.98. 

State: Kansas; 
Users per 1,000 beneficiaries[A,B]: 25; 
Visits per user[A]: 23; 
Visits per episode: 17.87. 

State: Kentucky; 
Users per 1,000 beneficiaries[A,B]: 40; 
Visits per user[A]: 30; 
Visits per episode: 19.65. 

State: Louisiana; 
Users per 1,000 beneficiaries[A,B]: 61; 
Visits per user[A]: 42; 
Visits per episode: 23.06. 

State: Maine; 
Users per 1,000 beneficiaries[A,B]: 45; 
Visits per user[A]: 25; 
Visits per episode: 18.28. 

State: Maryland; 
Users per 1,000 beneficiaries[A,B]: 32; 
Visits per user[A]: 19; 
Visits per episode: 15.64. 

State: Massachusetts; 
Users per 1,000 beneficiaries[A,B]: 57; 
Visits per user[A]: 28; 
Visits per episode: 20.02. 

State: Michigan; 
Users per 1,000 beneficiaries[A,B]: 45; 
Visits per user[A]: 23; 
Visits per episode: 17.83. 

State: Minnesota; 
Users per 1,000 beneficiaries[A,B]: 17; 
Visits per user[A]: 19; 
Visits per episode: 15.86. 

State: Mississippi; 
Users per 1,000 beneficiaries[A,B]: 51; 
Visits per user[A]: 33; 
Visits per episode: 20.36. 

State: Missouri; 
Users per 1,000 beneficiaries[A,B]: 40; 
Visits per user[A]: 22; 
Visits per episode: 16.15. 

State: Montana; 
Users per 1,000 beneficiaries[A,B]: 29; 
Visits per user[A]: 22; 
Visits per episode: 16.58. 

State: Nebraska; 
Users per 1,000 beneficiaries[A,B]: 27; 
Visits per user[A]: 20; 
Visits per episode: 15.67. 

State: Nevada; 
Users per 1,000 beneficiaries[A,B]: 27; 
Visits per user[A]: 23; 
Visits per episode: 17.91. 

State: New Hampshire; 
Users per 1,000 beneficiaries[A,B]: 43; 
Visits per user[A]: 25; 
Visits per episode: 18.61. 

State: New Jersey; 
Users per 1,000 beneficiaries[A,B]: 38; 
Visits per user[A]: 22; 
Visits per episode: 17.67. 

State: New Mexico; 
Users per 1,000 beneficiaries[A,B]: 30; 
Visits per user[A]: 23; 
Visits per episode: 16.41. 

State: New York; 
Users per 1,000 beneficiaries[A,B]: 37; 
Visits per user[A]: 27; 
Visits per episode: 21.09. 

State: North Carolina; 
Users per 1,000 beneficiaries[A,B]: 38; 
Visits per user[A]: 22; 
Visits per episode: 16.04. 

State: North Dakota; 
Users per 1,000 beneficiaries[A,B]: 30; 
Visits per user[A]: 20; 
Visits per episode: 16.17. 

State: Ohio; 
Users per 1,000 beneficiaries[A,B]: 33; 
Visits per user[A]: 22; 
Visits per episode: 17.24. 

State: Oklahoma; 
Users per 1,000 beneficiaries[A,B]: 47; 
Visits per user[A]: 37; 
Visits per episode: 22.73. 

State: Oregon; 
Users per 1,000 beneficiaries[A,B]: 30; 
Visits per user[A]: 16; 
Visits per episode: 12.02. 

State: Pennsylvania; 
Users per 1,000 beneficiaries[A,B]: 48; 
Visits per user[A]: 21; 
Visits per episode: 16.10. 

State: Rhode Island; 
Users per 1,000 beneficiaries[A,B]: 56; 
Visits per user[A]: 22; 
Visits per episode: 16.99. 

State: South Carolina; 
Users per 1,000 beneficiaries[A,B]: 37; 
Visits per user[A]: 22; 
Visits per episode: 16.16. 

State: South Dakota; 
Users per 1,000 beneficiaries[A,B]: 23; 
Visits per user[A]: 18; 
Visits per episode: 14.02. 

State: Tennessee; 
Users per 1,000 beneficiaries[A,B]: 43; 
Visits per user[A]: 31; 
Visits per episode: 20.81. 

State: Texas; 
Users per 1,000 beneficiaries[A,B]: 39; 
Visits per user[A]: 34; 
Visits per episode: 22.51. 

State: Utah; 
Users per 1,000 beneficiaries[A,B]: 34; 
Visits per user[A]: 39; 
Visits per episode: 28.44. 

State: Vermont; 
Users per 1,000 beneficiaries[A,B]: 57; 
Visits per user[A]: 25; 
Visits per episode: 17.08. 

State: Virginia; 
Users per 1,000 beneficiaries[A,B]: 34; 
Visits per user[A]: 24; 
Visits per episode: 17.47. 

State: Washington; 
Users per 1,000 beneficiaries[A,B]: 27; 
Visits per user[A]: 16; 
Visits per episode: 13.09. 

State: West Virginia; 
Users per 1,000 beneficiaries[A,B]: 29; 
Visits per user[A]: 22; 
Visits per episode: 15.46. 

State: Wisconsin; 
Users per 1,000 beneficiaries[A,B]: 23; 
Visits per user[A]: 21; 
Visits per episode: 16.14. 

State: Wyoming; 
Users per 1,000 beneficiaries[A,B]: 25; 
Visits per user[A]: 24; 
Visits per episode: 18.77. 

Nationwide: 
Users per 1,000 beneficiaries[A,B]: 38; 
Visits per user[A]: 25; 
Visits per episode: 18.65. 

[A] Figures reflect home health use during the first 6 months of 2001. 
They cannot be doubled to estimate home health use for the entire 
year. Doubling the 6-month figures would overestimate the number of 
users and visits. 

[B] Figures reflect users per 1,000 Medicare fee-for-service (FFS) 
beneficiaries. We use only Medicare FFS enrollees because CMS data on 
service use exclude those enrolled in managed care plans and because 
episode payments only apply to those receiving home health care under 
fee-for-service. 

Source: GAO analysis of CMS' home health claims (January-June 2001). 

[End of table] 

Table 2: Percentage of Medicare Home Health Users with Multiple 
Episodes, by State: 

State: Alabama; 
Home health users with only 1 episode: 53%; 
Home health users with 2 or more episodes: 47%. 

State: Alaska; 
Home health users with only 1 episode: 75%; 
Home health users with 2 or more episodes: 25%. 

State: Arizona; 
Home health users with only 1 episode: 75%; 
Home health users with 2 or more episodes: 25%. 

State: Arkansas; 
Home health users with only 1 episode: 56%; 
Home health users with 2 or more episodes: 44%. 

State: California; 
Home health users with only 1 episode: 67%; 
Home health users with 2 or more episodes: 33%. 

State: Colorado; 
Home health users with only 1 episode: 69%; 
Home health users with 2 or more episodes: 31%. 

State: Connecticut; 
Home health users with only 1 episode: 64%; 
Home health users with 2 or more episodes: 36%. 

State: Delaware; 
Home health users with only 1 episode: 72%; 
Home health users with 2 or more episodes: 28%. 

State: District of Columbia; 
Home health users with only 1 episode: 75%; 
Home health users with 2 or more episodes: 25%. 

State: Florida; 
Home health users with only 1 episode: 71%; 
Home health users with 2 or more episodes: 29%. 

State: Georgia; 
Home health users with only 1 episode: 59%; 
Home health users with 2 or more episodes: 41%. 

State: Hawaii; 
Home health users with only 1 episode: 76%; 
Home health users with 2 or more episodes: 24%. 

State: Idaho; 
Home health users with only 1 episode: 68%; 
Home health users with 2 or more episodes: 32%. 

State: Illinois; 
Home health users with only 1 episode: 66%; 
Home health users with 2 or more episodes: 34%. 

State: Indiana; 
Home health users with only 1 episode: 66%; 
Home health users with 2 or more episodes: 34%. 

State: Iowa; 
Home health users with only 1 episode: 72%; 
Home health users with 2 or more episodes: 28%. 

State: Kansas; 
Home health users with only 1 episode: 68%; 
Home health users with 2 or more episodes: 32%. 

State: Kentucky; 
Home health users with only 1 episode: 53%; 
Home health users with 2 or more episodes: 47%. 

State: Louisiana; 
Home health users with only 1 episode: 34%; 
Home health users with 2 or more episodes: 66%. 

State: Maine; 
Home health users with only 1 episode: 61%; 
Home health users with 2 or more episodes: 39%. 

State: Maryland; 
Home health users with only 1 episode: 76%; 
Home health users with 2 or more episodes: 24%. 

State: Massachusetts; 
Home health users with only 1 episode: 56%; 
Home health users with 2 or more episodes: 44%. 

State: Michigan; 
Home health users with only 1 episode: 68%; 
Home health users with 2 or more episodes: 32%. 

State: Minnesota; 
Home health users with only 1 episode: 76%; 
Home health users with 2 or more episodes: 24%. 

State: Mississippi; 
Home health users with only 1 episode: 44%; 
Home health users with 2 or more episodes: 56%. 

State: Missouri; 
Home health users with only 1 episode: 65%; 
Home health users with 2 or more episodes: 35%. 

State: Montana; 
Home health users with only 1 episode: 66%; 
Home health users with 2 or more episodes: 34%. 

State: Nebraska; 
Home health users with only 1 episode: 69%; 
Home health users with 2 or more episodes: 31%. 

State: Nevada; 
Home health users with only 1 episode: 71%; 
Home health users with 2 or more episodes: 29%. 

State: New Hampshire; 
Home health users with only 1 episode: 61%; 
Home health users with 2 or more episodes: 39%. 

State: New Jersey; 
Home health users with only 1 episode: 69%; 
Home health users with 2 or more episodes: 31%. 

State: New Mexico; 
Home health users with only 1 episode: 61%; 
Home health users with 2 or more episodes: 39%. 

State: New York; 
Home health users with only 1 episode: 69%; 
Home health users with 2 or more episodes: 31%. 

State: North Carolina; 
Home health users with only 1 episode: 63%; 
Home health users with 2 or more episodes: 37%. 

State: North Dakota; 
Home health users with only 1 episode: 72%; 
Home health users with 2 or more episodes: 28%. 

State: Ohio; 
Home health users with only 1 episode: 68%; 
Home health users with 2 or more episodes: 32%. 

State: Oklahoma; 
Home health users with only 1 episode: 45%; 
Home health users with 2 or more episodes: 55%. 

State: Oregon; 
Home health users with only 1 episode: 69%; 
Home health users with 2 or more episodes: 31%. 

State: Pennsylvania; 
Home health users with only 1 episode: 67%; 
Home health users with 2 or more episodes: 33%. 

State: Rhode Island; 
Home health users with only 1 episode: 66%; 
Home health users with 2 or more episodes: 34%. 

State: South Carolina; 
Home health users with only 1 episode: 62%; 
Home health users with 2 or more episodes: 38%. 

State: South Dakota; 
Home health users with only 1 episode: 72%; 
Home health users with 2 or more episodes: 28%. 

State: Tennessee; 
Home health users with only 1 episode: 52%; 
Home health users with 2 or more episodes: 48%. 

State: Texas; 
Home health users with only 1 episode: 52%; 
Home health users with 2 or more episodes: 48%. 

State: Utah; 
Home health users with only 1 episode: 62%; 
Home health users with 2 or more episodes: 38%. 

State: Vermont; 
Home health users with only 1 episode: 46%; 
Home health users with 2 or more episodes: 54%. 

State: Virginia; 
Home health users with only 1 episode: 64%; 
Home health users with 2 or more episodes: 36%. 

State: Washington; 
Home health users with only 1 episode: 72%; 
Home health users with 2 or more episodes: 28%. 

State: West Virginia; 
Home health users with only 1 episode: 60%; 
Home health users with 2 or more episodes: 40%. 

State: Wisconsin; 
Home health users with only 1 episode: 70%; 
Home health users with 2 or more episodes: 30%. 

State: Wyoming; 
Home health users with only 1 episode: 69%; 
Home health users with 2 or more episodes: 31%. 

Nationwide: 
Home health users with only 1 episode: 63%; 
Home health users with 2 or more episodes: 37%. 

Note: Home health users include all FFS beneficiaries who had an 
episode ending during the first 3 months of 2001. Those with two or 
more episodes had at least one additional episode during the first 6 
months of 2001. 

Source: GAO analysis of CMS' home health claims (January-June 2001). 

[End of table] 

[End of enclosure] 

Enclosure II: Scope and Methodology: 

We used data from Medicare provider, claims, and beneficiary files for 
calendar year 2001. We examined data on Medicare fee for service 
beneficiaries only. To count the number of home health users, the 
average number of visits per user, the number of episodes, and the 
average number of visits per episode, we selected Medicare claims for 
all episodes ending on January 1, 2001 through June 30, 2001 from the 
home health Standard Analytic File for 2001 that were available as of 
January 24, 2002. We included as episodes those periods of care that 
comprised four or fewer visits, for which the home health agency 
received a low utilization payment adjustment. To calculate the share 
of home health users with multiple episodes, we used claims data to 
identify all beneficiaries who had an episode that ended in the first 
3 months of the year and then determined whether they received any 
additional episodes of care during the first 6 months of 2001. Our 
file of 1.76 million episodes does not include any claims for the 
first 6 months of 2001 submitted after January 24, 2002. 

[End of enclosure]