[20040412]RS21814_医疗保险家庭健康-福利和付款.pdf

1 For a complete discussion of cost sharing in Medicare home health, see CRS Report RL31628,Medicares Home Health Benefit: Cost Sharing Issues and Options, by Carolyn Merck.Congressional Research Service The Library of CongressCRS Report for CongressReceived through the CRS WebOrder Code RS21814April 12, 2004Medicare Home Health Benefits and PaymentsJennifer BoulangerSpecialist in Social LegislationDomestic Social Policy DivisionSummaryMedicare pays for unlimited care in the home as long as the following criteria aremet: the beneficiary is “homebound,” in need of skilled care on an intermittent basis,and under the care of a physician. Beneficiaries do not have any cost sharingrequirements for home health services.1Medicare pays home health agencies (HHA) using a prospective payment system(PPS). Under home health PPS, Medicare makes a payment for every 60-day episodeof care that an eligible beneficiary receives. This episode payment is adjusted to reflectthe intensity of beneficiary care needs using home health resource groups (HHRGs).Congress, in the Medicare Prescription Drug, Improvement, and Modernization Actof 2003 (MMA) made a number of changes to home health agency payments i