House passes BBA reform bill; final deal imminent
By MATTHEW HAY
HHBR Washington Correspondent
WASHINGTON The U.S House of Representatives overwhelmingly passed a Balanced Budget Act of 1997 (BBA) reform bill on Friday that would postpone the 15% reduction in home health reimbursement until one year after the new prospective payment system (PPS) is in place. The vote was 388 to 25. The bill, which is estimated to cost about $11 billion over five years, is designed to address some of the unintended consequences of the BBA.
Now the House bill must be reconciled with the Senate Finance bill, which would phase-in rather than postpone the 15% cut. House and Senate negotiators met over the weekend to hammer out the differences between the two bills. Congress hopes to adjourn for the year on Wednesday.
Notably, the House bill also requires the Secretary of Health and Human Services (Washington) to report to Congress, within six months of the PPS’ implementation, on the need for an additional 15% reduction.
The bill would also pay home health agencies $10 for every Medicare beneficiary to help offset costs associated with implementation of OASIS and require the General Accounting Office (Washington) to assess the actual costs home health agencies incur through OASIS data collection as well as its impact on patient privacy.
The legislation would also limit the surety bond requirement to four years and eliminate the requirement that agencies purchase separate surety bonds for Medicare and Medicaid. The value of the surety bond would be limited to $50,000 or 10% of the home health agency’s Medicare payments in the previous year, whichever is less.
In addition, it would freeze HCFA’s inherent reasonableness (IR) authority until the agency promulgates new regulations through the formal notice and comment process. That would eliminate HCFA’s ability to cut reimbursement up to 15% in a single year without formal notice or comment.
Finally, the bill would provide a price update for durable medical equipment (DME) and oxygen equal to the consumer price index, minus 2% for FY01 and FY02.
Final deal sought
The widespread expectation is that House Ways and Means Health Subcommittee Chairman Bill Thomas (R-CA) will prevail concerning the 15% reduction.
"Thomas usually gets his way on these issues with [Senate Finance Committee Chairman] Bill Roth," said one home care lobbyist. "That looks very promising, but you can’t count these things until you see it done."
One home care lobbyist reported that when budget negotiations turned to home health, Senate Majority Leader Trent Lott signaled that that he favored delay of the 15% cut over a phase-in. "The Democrats had already proposed a delay instead of a phase-in, so there was a lot of support for it," said the lobbyist. "That is why we think they are going to go with the House approach."
"Our goal at this point is to end up with the House approach to the 15% reduction and add some of the items from the Senate bill, such as an increase in the per-visit limits and an increase in the per-beneficiary limits," said National Association for Home Care’s (Washington) Bill Dombi. He said NAHC also wants to see an extension of periodic interim payments included in the final agreement.
"Another very crucial item is the elimination of consolidated billing," added Dombi. "We would live with the 15-minute requirement because people are already doing it, but we don’t understand why Thomas would dig his heels in on the consolidated billing requirement because it really does not have any affect on the Medicare budget."
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