title: Medicare home health care patient case-mix before and after the Balanced Budget Act of 1997: effect on dual eligible beneficiaries.
abstract: The Balanced Budget Act (BBA) of 1997 changed the payment system for Medicare home health care (HHC) from cost-based to prospective reimbursement. We used Medical Expenditure Panel Survey data to assess the impact of the BBA on Medicare HHC patient case-mix measured by the Centers for Medicare and Medicaid Services Hierarchical Condition Categories (CMS-HCC) model. There was a significant increase in Medicare HHC patient case-mix between the pre-BBA and Prospective Payment System (PPS) periods. The increase in the standardized-predicted risk score from the Interim Payment System period to PPS was nearly 4 times greater for the dual eligibles (Medicare-Medicaid) than for the Medicare-only population. This significantly greater rise in the HHC resources required by dual eligibles as compared to nonduals could be due to a shift in HHC payers from Medicare only to Medicaid rather than be an actual increase in case-mix per se.
authors: a University of Rochester , Rochester , New York , USA.
authors: Huai-Che
authors: HC
authors: Shih
authors: Helena
authors: H
authors: Temkin-Greener
authors: Kathryn
authors: K
authors: Votava
authors: Bruce
authors: B
authors: Friedman
mesh_terms: D000368:Aged; D002017:Budgets / Q000331:legislation & jurisprudence; D003953:Diagnosis-Related Groups; D004608:Eligibility Determination / Q000379:methods*; D018166:Health Care Reform / Q000331:legislation & jurisprudence; D006302:Health Services Research; D006699:Home Care Services / Q000191:economics* / Q000331:legislation & jurisprudence; D006801:Humans; D008134:Long-Term Care / Q000191:economics / Q000331:legislation & jurisprudence; D008484:Medicaid / Q000331:legislation & jurisprudence; D006278:Medicare; D015999:Multivariate Analysis; D011445:Prospective Payment System / Q000191:economics; D012051:Reimbursement Mechanisms / Q000191:economics; D014481:United States