The cuts proposed for 2025 will further exacerbate the disparity for thousands of elderly patients on the island
Medicare es un programa de seguro médico del gobierno federal de Estados Unidos para personas de 65 años o más. Crédito: Jenny Kane | AP
New York – The Puerto Rico Medicaid and Medicare Advantage Products Association (MMAPA) and other organizations asked the Centers for Medicaid and Medicare Services (CMS) not to reduce the wage index for providers under the traditional Medicare Home Health Prospective Payment System (HHPPS) by 2025, as it worsens the island's disparity problem compared to the states.
According to the new rule proposed by CMS, starting next year, wage index values for municipalities in the territory would be calculated under a new methodology that would translate into a 20.64% reduction in reimbursements received by companies that provide home health care services under Medicare.
The proposed rule, which would be effective starting next January if CMS does not make an administrative decision in the opposite direction, will reduce the minimum from 0.4 to 0.3 average in the case of municipalities in Puerto Rico.
“If we go by the principle of equity, the implication of that level in that payment index is that in Puerto Rico things can be done with a quarter of the resources or the cost at the national level, even though we are paying the same price for medicines and the same payroll tax that American citizens pay in the US for Medicare,” contrasted Roberto Pando, spokesman for MMAPA and president of the Medicare Advantage Committee in the association.
In an exclusive interview with El Diario, the spokesman explained that this type of benefit applies to senior citizens who leave the hospital and continue medical treatment from their homes.
Prospective payment is another service under traditional Medicare that defines a fee-for-service rate for providers, in this case for home care.
“Typically, Medicare home care is, when people leave the hospital, and are basically bedridden, and they are given nursing services, occupational therapy; Sometimes, you have to give them intravenous medication, and that is what is defined as home care service,” explained the MMAPA spokesperson.
“Medicare payments have a geographic salary indicator that basically impacts the municipality level and is paid depending on what Medicare estimates the professional compensation costs or what it costs to offer a service in a certain jurisdiction or county,” he added.
In the case of Puerto Rico, the Medicare rate schedule is already paying for services at less than a third of what it pays on average at the national level.
Because older adults in Puerto Rico rely more on home health care services compared to other states and US territories, reductions in reimbursement will have a disproportionate impact on this population.
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