The nonprofit agencies that provide home-based health care to thousands of residents across Vermont are bracing for a hit to the federal funds that account for the majority of their operating revenue.
The Centers for Medicare and Medicaid Services issued new rules recently that will change the qualifying criteria for supplementary payments to “home health and hospice” agencies that provide care in rural settings. The changes affect seven of the 10 home health agencies in the state.
Jill Olson, executive director of the VNAs of Vermont, the trade association for home health agencies in Vermont, said the decision will result in funding cuts of about $1.2 million annually, once the so-called “rural add-on” is phased out entirely.
“This is a significant payment cut for rural providers, and we’re very concerned that Congress has allowed this to happen,” Olson says.
The loss of the rural add-on follows a decade of incremental reductions in Medicare reimbursement rates for home health agencies in Vermont, according to Olson. And while those reimbursement rates are set to rise by 2 percent in 2019, Medicare rates for the home health providers are down by 14 percent since 2009.
Olson said the agencies have done their best in recent years to absorb the funding reductions. She said the loss of the rural add-on, however, “means it’s harder and harder for us to balance all of that out.”
Last year, home health workers — they include registered nurses, licensed nursing assistants and personal care providers — drove 6 million miles to make 1 million patient visits in Vermont.
Their clients include patients like Flora Palm, an 88-year-old woman who lives alone in her small ranch house in St. Albans.
Palm gets visits almost daily from workers at the Franklin County Home Health Agency. They check vital signs, bandage wounds, organize medications and help with bathing — tasks Palm can no longer do for herself.
“I’m so thankful ... because I’d be in a nursing home if I didn’t have this,” Palm said. “And I don’t want to be in a nursing home.”
Demographically, Vermont is one of the oldest states in the country. And making sure senior citizens can live at home, and be independent, is one of the biggest challenges facing the state’s health care industry.
Rep. Dave Yacovone, a state representative from Morrisville who formerly served as a commissioner at the Vermont Agency of Human Services, said home health agencies play a critical role in rising to that challenge.
“I’ve often thought of our home health agencies as the connective tissue, if you will, that brings together families and individuals with their medical providers in ways that none of us could do on our own,” Yacovone said. “Whether you’re a young mom fighting maternal depression who needs help from the nursing staff, or you’re a senior citizen recovering from a stroke, the sphere of people that are touched by home health in our state is just huge.”
Yacovone was among the lawmakers who pushed for inflationary increases in the state’s contribution to home health budgets over the past two legislative sessions. Those increases, however, have been sporadic over the past decade. And Yacovone said those annual increases need to become standard operating procedure, rather than a one-off event in years where lawmakers can find the extra money.
“It’s not unlike in many ways our roads and bridges in Vermont that need attention,” Yacovone said. “And if you don’t take care of them, something bad will happen.”