Medicare Home Health Benefit Changes during COVID to Assist Bleeding Disorder Patients
By Ellen Riker

On Monday, March 30, CMS released an Interim Final Rule related to Medicare waivers and policy changes occurring during the current COVID-19 emergency. The rule includes significant changes to how and where hospital inpatient services may be provided, the provision of telehealth services by numerous providers and facilities, and changes to the Medicare Home Health Benefit. The Alliance Washington Team prepared a summary of the major provisions of the rule, which can be found here.

The Rule’s Home Health Benefit changes may help HTCs serve Medicare patients with bleeding disorders who are not able to self-administer their treatments. Historically, hemophilia and other bleeding disorders patients would not qualify for the Medicare home health benefit because they did not meet a stringent definition of homebound (literally not able to leave the home). Under the rule, CMS is redefining the definition of homebound during the COVID emergency. If the treating physician reports that it is medically contraindicated for the patient to leave the home, the patient will meet the homebound standard and qualify for home health benefits.

There are other requirements, which patients must meet to qualify for home health benefits, including that the patient must be under the care of a physician and have a plan of care established and periodically reviewed by a physician. In addition, the patient must be in need of skilled nursing care on an intermittent basis or physical therapy or speech-language pathology or a continuing need for occupational therapy.

HTCs should contact home health care agencies in their area. Under the home health benefit these agencies are able to contract with the HTC for bleeding disorders products and infusion services if they are not able to provide them directly. The home health agency should be able to tell you how to bill for treatments, but contact the Alliance for assistance if needed.

For more information please see the discussion in the Interim Final Rule on this topic here on pages 60-64 (with the most relevant information on pages 62-63). More information on the Medicare home health benefit can be found here.