Poster Paper: A Twenty Year Snapshot of Medicare Home Health Care Payment Reform-A Systematic Review

Friday, November 3, 2017
Regency Ballroom (Hyatt Regency Chicago)

*Names in bold indicate Presenter

Jamila M. Torain, University of Maryland


Home Health Care (HHC) is a wide range of health care services that can be given in your home for an illness or injury. HHC is a more convenient, less expensive service essential to the post-acute health of Medicare beneficiaries and a major predictor of long-term health outcomes. However, the HHC reimbursement structure has been subjected to major reforms which authorized the rebasing of home health payments, ultimately affecting both providers’ ability to deliver health care and utilization of services by beneficiaries.

The Balanced Budget Act and the Affordable Care Act are two major pieces of legislation that mandated budget reductions to make up for overpayments for home health services over the past two decades (rebasing). Although the most studied in the literature, these two acts are not the only policy that has effected the HHC budget.


Current literature lacks a comprehensive review of all legislation that mandated major budget cuts to HHC. The goals of this review were to (1) identify and describe all legislation pertaining to the Medicare home health care reimbursement structure, (2) to evaluate the current evidence of the effects of the legislation on both providers’ ability to deliver health care and utilization of services by beneficiaries, and (3) to critically examine and discuss the unintended and/or proposed consequences of each policy change.


I conducted a systematic PubMed search of all peer reviewed journal articles published between 1990-2016, focusing on the Medicare home health care budget with the following search terms: (1) “home health care” or “home health” or “home health care agencies”, (2) “payment reform” or “payment reduction” or “rebasing”, and (3) “Medicare policy” or “policy” or “legislation”.


Eighteen papers were identified and selected on the basis of describing policy that has changed the HHC payment structure. These papers identified and described seven major payment reforms that mandated changes to the HHC payment system and their proposed and unintended consequences.