Shift to Home May Be Coming for SNFs as Choose Home Bill Introduced in the House

The need to consider offering at-home services may be accelerating for nursing home operators as the Choose Home Care Act of 2021 was introduced in the House of Representatives on Friday.

The bill was first introduced in July in the U.S. Senate by Sens. Debbie Stabenow (D-MI) and Todd Young (R-IN).

A bipartisan effort, the legislation is intended to give Americans more choice on where to recover following a hospital stay. The bill would create an add-on payment to the traditional Medicare home health benefit for patients 30 days after their hospital discharge.

At the time, LeadingAge, which represents more than 5,000 nonprofit operators, supported Choose Home as it gives older Americans access to a range of affordable care and services to meet their needs.

A spokesperson with the organization renewed that support to Skilled Nursing News on Friday.

The American Health Care Association and National Center for Assisted Living (AHCA/NCAL), which represents more than 14,000 SNF operators, assisted living communities and sub-acute centers, took a different tone.

“AHCA/NCAL strongly supports rational population health framework approaches to offer beneficiaries preferred care options,” a statement sent to SNN said. “However, we adamantly oppose cutting skilled nursing benefit day and coinsurance coverage protections, that have been in place for decades, to finance an untested expansion fo the home health benefit.”

It pointed to a MedPAC report, released in March 2021, that shows that home health aide visits declined from 13.4 visits in 1998 to 1.3 visits in 2019, despite no change in the underlying home health aide benefit.

““We need proposals that add options for Medicare beneficiaries, not limit them,” the statement said. “We hope to work with members of Congress to bring forth a solution that promotes choice, flexibility, and quality for post-acute services as envisioned by the IMPACT Act, and not create additional silos.”

The House companion bill is reportedly cosponsored by Representatives Sanford Bishop, Jr. (D-GA), Brendan Boyle (D-PA), Buddy Carter (R-GA), Dwight Evans (D-PA), Vicente Gonzalez (D-TX), Brian Higgins (D-NY), Clay Higgins (R-LA), Eleanor Holmes Norton (D-DC), Mike Johnson (R-LA), Tom O’Halleran (D-AZ), Tom Suozzi (D-NY) and Paul Tonko (D-NY).

In a statement in support of the piece of legislation, the National Association for Home Care & Hospice and Partnership for Quality Home commended the bill on Friday and said the support it’s received since it was first introduced in July shows how important it is to increase access to safe, cost-effective care at home for Medicare beneficiaries after hospitalization.

An at-home care program was shown to decrease 30-day emergency department (ED) visit escalation, avert $904,000 in ED/hospitalization costs and improve 30-day hospital admittance rates for UnityPoint Health, a Des, Moines, Iowa-based health system that plans to further expand its SNF-at-home to match current patient preference.

During SNN’s RETHINK conference in September, both Carespring Heath Care Management CEO Chris Chirumbolo and Ignite Medical Resorts CEO and Co-Founder Tim Field indicated that they didn’t consider the push to home care to be a threat to their operations in light of the Choose Home Bill’s introduction.

“I think it’s a complement, it’s not a competitor,” Fields said.

Ignite operates a portfolio of 10 short-term rehab facilities in Wisconsin, Illinois, Missouri, Kansas and Oklahoma.

An estimated 35% of nursing home patients could be diverted to home health care if the Choose Home Care Act of 2021 becomes law, according to Keith Myers, chairman and CEO of LHC Group, who spoke on a panel at Home Health Care News’ FUTURE conference last week.