New bill would slash surety bond amount in half
Finally, some good news for home health agencies: Less than two weeks after the Small Business Administration unleashed a stinging criticism of HCFA's handling of the home health surety bond fiasco, two prominent senators have introduced a bill that would slash the bond requirement from $50,000 to $25,000.
Having seen their hopes dashed before, home care associations are nevertheless guardedly optimistic about these recent developments. Even so, it remains to be seen whether the pressure will be sufficient to coax HCFA into making substantive changes to its final revision to the rule. (Final rule nears completion, page 4.)
What's new and encouraging about the bill is that it would modify the surety bond requirement outlined in the Balanced Budget Act so that only newly certified agencies would have to obtain surety bonds, and would reduce the amount of the bond to $25,000. According to its sponsors, "the Health Care Financing Administration's surety bond rule goes far beyond Congress' intention to keep bad providers from entering Medicare, causing many existing agencies with no history of fraud to be unable to obtain bonds. [We] would force HCFA to return to Congress' original intention."
That's music to the ears of home health advocates. Both the National Association for Home Care in Washington, DC and the American Federation of Home Health Agencies have endorsed the bill, even though some provisions concern them.
Particularly worrisome is the provision that would "reform bankruptcy rules to make it harder for all Medicare providers (not only home health care agencies) to avoid penalties and payment obligations by declaring bankruptcy."
That's a tough pill for home health agencies to swallow given that changes made to the Interim Payment System have led to financial hardships for many. "So many home health agencies at this point have been bankrupted by the IPS," says Ann Howard, executive director of the Silver Spring, MD-based AFHHA. Many others are in trouble too, she maintains.
The bill (S. 2031), sponsored by Sens. Chuck Grassley (R-IA) and John Breaux (D-LA), is being sold as a "comprehensive bill to fight home health care fraud." But many of the anti-fraud provisions the bill contains are already in place at HCFA, notes Howard.
The bill would:
- Heighten scrutiny of new home health agencies before they enter the Medicare program and during their early years of Medicare participation;
- Improve standards and screening for home health agency administrators and employees;
- Require that agencies adopt and implement fraud and abuse compliance programs;
- Make more information on particular home health agencies available to beneficiaries;
- Create an interagency Home Health Integrity Task Force, led by the Office of the Inspector General;
- Require audits of home health agencies whose claims exhibit unusual features that may indicate problems.
Howard likes the fact that the bill would mandate that there be objective standards for triggering of additional audits, though she remains concerned about "certain imprecise definitions" in the bill. For example, under the bill, a home health agency is likely to get additional audit visits if it has experienced unusually rapid growth or has unusually high utilization compared to other agencies in the area or across the country. "Well, every home health agency in Texas has high utilization compared to agencies in Vermont," she says.
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