Jeffords introduces latest home care bill to Congress
By MATTHEW HAY
HHBR Washington Correspondent
WASHINGTON Sen. Jim Jeffords (R-VT) last week introduced the latest in what has become a flood of home care bills introduced in this session of Congress. But industry representatives say it is not likely to be the last.
Jeffords’ bill, Preserving Access to Care in the HOME Act of 1999 (PATCH), would eliminate the 15% across-the-board reduction, add payment for medically complex patients, and clarify Medicare’s definition of homebound. It would also tie review rates to historical denial rates and monitor the development of the prospective payment system for home healthcare.
Jeffords’ bill immediately gained widespread attention in Congress, largely because of his dual role as a member of the Senate Finance Committee and chairman of the Senate Committee on Health, Education, Labor and Pensions. The bill was co-sponsored by several outspoken Democrats, including Sens. Patrick Leahy (D-VT) and Barbara Mikulski (D-MD). Those factors, along with the strong endorsement of seniors groups, including the National Council on the Aging (Washington), make Jeffords’ bill a serious contender.
Jeffords’ bill includes two key provisions that are also found in virtually every major home care bill introduced in the House or Senate so far this year. The first would eliminate the mandatory 15% reduction in cost limits scheduled for Oct. 1, 2000. Home care representatives say they are now optimistic that Congress will pass some form of legislation that addresses the problems brought about by the Balanced Budget Act of 1997 (BBA) and that this provision will be included.
The latest analysis released by the Congressional Budget Office (CBO; Washington) earlier this month confirmed the fact that the BBA cut nearly three times the estimated $16 billion from Medicare home health outlays that was originally predicted. That fact has taken hold on Capitol Hill, and there is no appetite in Congress for further cuts. "We know that Medicare cuts have saved more money than anticipated and that this automatic reduction is no longer necessary," asserted Leahy.
Nevertheless, representatives warn that CBO will score the elimination of the 15% reduction as an additional cost, and that will make it that much tougher to win support for other provisions.
Like many of the bills already introduced, Jeffords’ bill would create an outlier provision for high-cost, medically complex patients. But while home care representatives are also generally optimistic about this provision, it is far from certain what shape it will take. For example, the outlier provision in Jeffords’ bill would restore an estimated $1 billion in home health payments over several years, while the outlier provision introduced earlier this year in the House by Reps. Tom Coburn (R-OK), Jim McGovern (D-MA), and Robert Weygand (D-RI) would cap that amount at $250 million over the same period.
Jeffords’ bill would also address "the confusing definition of homebound" currently used by the Medicare program. His bill aims to clarify the definition of homebound so that coverage decisions are based on the condition of the individual and not on "an arbitrary number of absences from the home." According to Jeffords, "Many seniors have found themselves virtual prisoners in their homes, threatened with loss of coverage if they attend adult day care, weekly religious services, or even visit family members in the hospital."
The latest chapter in this debate came earlier this year when the Health Care Financing Administration (Baltimore) released a report mandated by the BBA on homebound eligibility criteria for Medicare home health services. In that report, the agency said its analysis yielded no new options superior to the current definition. However, it also noted that that could change once the agency begins accumulating information through OASIS.
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