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Home Care in Rural America
Several provisions of the Balanced Budget Act of 1997 (BBA) have affected Medicare-covered home health care, including the interim payment system and the introduction of a prospective payment system for Medicare services. In two previous studies, Project HOPE examined the impact of the BBA on rural home health agencies (HHAs) and rural Medicare home care users. This third examination of rural home care links the two previous studies by profiling the types of HHAs providing services to rural beneficiaries. Using bivariate analyses, we examine the characteristics of agencies serving rural Medicare beneficiaries, including whether beneficiaries were served by an agency in their county. The results of this analysis will provide rural advocates and policymakers with the necessary information to monitor the impact of home health payment reforms and to ensure that access to care is not impaired.
Publications
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Home Health Payment Reform: Trends In The Supply Of Rural Agencies And Availability Of Home-Based Skilled Services
Author(s): Janet P. Sutton
Report Number: Policy Analysis Brief, W Series No. 6
Date: 03 / 2005
Findings from this study suggest that changes in home health reimbursement were associated with dramatic reductions in the supply of home care agencies; however those reductions appear to have occurred primarily during the time in which the Interim Payment System was in place. Although proportionately fewer rural agencies closed between 1998 and 2000, the closure of a rural agency may have a greater impact on access since many communities are experiencing critical shortages of providers. In the post-PPS period, agency supply became more stable, but closure rates were higher among rural agencies.
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