Dispelling a Myth: Medicare Home Health Coverage is NOT a Short Term, Post-Acute Care Benefit

Few people know that Congress decided years ago to remove caps and prior institutional prerequisites for Medicare's home health benefit. As policies, practices and decision-makers increasingly insist that Medicare home health coverage is intended to be short-term and for people with recent hospital stays, it is important to know this is not true. Indeed, the Omnibus Reconciliation Act of 1980 (P.L. 96-499) expanded the Medicare home health benefit. This law eliminated the annual 100-visit cap and prior hospitalization requirement that existed at the time. The legislative history of the law demonstrates that Congress intended to "liberalize" the home health benefit.[1] Congress expressly stated that unlimited visits would be available[2] and that by eliminating the prior hospitalization requirement, more than 1.1 million beneficiaries would have access to home health care as an alternative to or postponement of hospitalization.[3]

Medicare home health care is often mistakenly referred to as a short term, post-acute care benefit. Since eliminating the annual 100-visit cap and the prior hospitalization requirement in 1980, however, Congress has not acted to reintroduce such limitations. CMS, MedPAC and others should not use payment rules, quality measures, or other vehicles and pronouncements to undermine the express Congressional intent to allow people to remain at home with Medicare-covered home health care so long as they qualify. 

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[1] Conference Report - September 4, 1980 - Congressional Record - House - pg 24206.
[2] Amendments to the Medicare Program - Subcommittee on Health of the Committee on Ways and Means - June 15, 1979