Nurse pushing a senior Latin American man on a wheelchair leaving the hospital and wearing facemasks during the COVID-19 pandemic

Home care providers offered both positive and negative feedback to a federal proposal that would establish a quality measure to assess the percentage of Medicaid beneficiaries who are discharged from inpatient facilities to home- and community-based services (HCBS) settings.

The Centers for Medicare and Medicaid Services’ state-level concept aims to assist quality improvement in relation to HCBS planning. CMS’s goal is to provide data that will enhance the quality of services provided to individuals discharged from inpatient facilities. 

“It is very encouraging that CMS is exploring expanding Medicaid data acquisition to include the incidence of discharges from inpatient facilities to the patient’s home as a quality-of-care measure,” National Association for Home Care & Hospice President William Dombi said in a statement to McKnight’s Home Care Daily Pulse. “There is a significant need for data of this nature in Medicaid as HCBS use continues to be the central post-acute service in Medicaid. Indications are strong that increased use of home care in Medicaid will pay dividends to both patients and Medicaid through reductions in high-cost care and improved clinical outcomes for patients.”

Other providers were more critical of the idea. LeadingAge Director of Medicaid Policy Georgia Goodman told McKnight’s Home Care Daily Pulse that the proposal’s framework needs more clarification.

“The framework references multiple possible goals but lacks adequate clarity to incentivize quality improvement in the Medicaid program,” she said. “If the proposal is refined to provide states with data for planning or service expansion in Medicaid home and community-based services programs, home health providers may benefit from increased demand for services.”

LeadingAge urged CMS to “further distill their objectives to better reflect a singular goal” in comments made to the Lewin Group earlier this month on the proposed framework.

“Because of the lack of clarity of the proposal, refinement could lead to a measure that assesses quality of Medicaid home health services for individuals that were discharged from inpatient facilities,” Goodman said. “Should CMS consider this route, we urge consistency of metrics across payers and look forward to ongoing opportunities to assist with development of such a measure.”