Congress is set to sort out BBA corrections this month
By MATTHEW HAY
HHBR Washington Correspondent
WASHINGTON Congress returns from its August recess this week, and high on its agenda will be a package of reforms to the Balanced Budget Act of 1997 (BBA). The good news is that the needs of the home care industry are clearly on the congressional radar screen. The bad news is that so are the needs of other providers, namely hospitals and skilled nursing facilities.
Congressional sources now predict that Congress will pass a so-called BBA fixings bill no smaller than the $7.5 billion over 10 years that was proposed by the White House in its Medicare proposal earlier this year, but possibly as high as $30 billion.
Aides to House Ways and Means Health Subcommittee Chairman Rep. Bill Thomas (R-CA) say he plans to push a bill that addresses BBA corrections early this month.
Senate Finance Committee aides say that committee also plans to act quickly, but the Senate Finance bill will likely be more comprehensive. In addition to BBA corrections, the Senate Finance bill will include other targeted Medicare reform items, such as an update to the standard benefits package and a prescription drug benefit. It is also expected to include a means-testing provision and changes in Medicare’s copayment and deductible structure.
The White House is also anxious to pass some version of Medicare reform legislation by year’s end. Speaking at the National Press Club last week, White House Chief of Staff John Podesta signaled that the Administration will try to broker a deal with the Senate Finance Committee that includes a prescription drug benefit. Also high on the Administration’s agenda is a patient’s bill of rights. That item seems more likely now that the measure has gathered more support than originally expected from Republicans.
A flood of home care reform bills were introduced before Congress recessed last month. The home care industry’s latest strategy will be to have Sen. Connie Mack’s (R-FL) proposal for a simplified back-up prospective payment system for home health rolled into one of the more comprehensive bills, such as the ones introduced by Sen. Jim Jeffords (R-VT) or Sen. Kit Bond (R-MO). Those two bills, while not identical, would both eliminate the 15% across-the board cut in home health reimbursement and include an outlier provision for high-cost, medically complex patients.
Home care representatives will make their final push for these items during a mid-September home care rally supported by all five national home care associations.
Privacy legislation also on the agenda
BBA corrections are not the only healthcare-related item competing for attention, however. Congress packed its bags last month without passing patient confidentiality legislation required by the Health Insurance Portability and Accountability Act of 1996. Technically, that hands the task of drafting regulations over to the Department of Health and Human Services (HHS; Washington). But the more likely next step is that Congress will extend its own deadline. "Congress shows no sign of throwing in the towel on this," said Roy Bussewitz of the National Association of Chain Drug Stores (Alexandria, VA). "This issue is still front and center on its agenda."
HHS Assistant Secretary for Planning and Evaluation Margaret Hamburg recently told the Ways and Means Health Subcommittee that parties that knowingly obtain or use healthcare information in violation of the standards should be subject to criminal felony penalties. "The penalties mandated in privacy legislation should be higher when violations are for monetary gain," she added. At the same hearing, Health Care Financing Administration (Baltimore) Deputy Director Mike Hash tried to split the difference on the contentious area of federal preemption of state laws. "Our recommendations call for national standards," he said. "But, we do not recommend outright or overall federal preemption of existing state laws that are more protective of health information."
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