NAHC highlights its crowded legislative and regulatory agenda
By MATTHEW HAY
HHBR Washington Correspondent
WASHINGTON - The National Association for Home Care (NAHC; Washington) on Sunday night outlined a busy legislative and regulatory agenda as home health agencies enter the final turn leading to the transition to a prospective payment system (PPS) for home health. The update came on the opening day of NAHC's National Policy Conference in Washington, DC.
NAHC is actively pursuing co-signers for separate bills in the House and Senate that would put the final nail in the coffin for the additional 15% reduction in Medicare home health spending still technically slated for next year. Sentiment has swung decisively against the additional cut but NAHC is not taking any chances.
In the Senate, the Home Health Payment Fairness Act, which would strike the additional reduction, has already gathered 18 original co-signers. That bill is being spearheaded by the offices of Sen. Kit Bond (R-MO), Sen. Susan Collins (R-ME), and Sen. Jim Jeffords (R-VT), each of whom chair an important committee. A similar bill is also expected in the House.
NAHC's Theresa Forester also noted several workforce issues likely to surface this year. She said NAHC expects a $1 increase in the minimum wage over a 2-year period. But she added that the average wage for a home care aide ranges between $7 and $9 an hour, which is already ahead of the $6.15 that would be established under the increase.
Forrester also reported that Jeffords, as head of the Health, Education, Labor and Pensions Committee, is spearheading an effort to examine the paraprofessional workforce. According to Forrester, Jeffords' staff now say they expect to get a series of reports on this issue from the General Accounting Office (GAO; Washington). The first will cover the demographics of the paraprofessional workforce including wages and benefits. The second will examine employers.
"We think that will be a useful tool when we go to Congress and talk about the difficulties associated with worker shortage and also when we go to the Medicare Payment Advisory Commission and talk about some of the staffing problems that agencies are having," she reported.
On the regulatory front, the picture is far more crowded. According to NAHC's Mary St. Pierre, the most likely changes in the final rule for HCFA's prospective payment system are elimination of the requirement for a signed order for submission of the initial claim and a 60% up-front payment for that claim. She said the agency is also working to at least hold the line on the episode rate and increase the rate for the low utilization payment adjuster (LUPA).
St. Pierre said HCFA has requested certain code changes from the National Uniform Billing Committee (NUBC) in order to prepare for PPS. One of those changes is for a code that would let agencies bill for patients that have been discharged even though the full 60-day episode has not elapsed.
"That gives us a clue that agencies may be able to bill as soon as the episode ends even though the 60-day episode is not complete," she explained.
She also reported that the final regulation for conditions of participation is now expected in September or early fall. "We are really pressuring HCFA to be certain to give home health agencies adequate time to make changes and implement new systems for this major change in conditions of participation," she said.
St. Pierre also reported that HCFA is on the brink of releasing a Federal Register notice that includes encryption requirements for OASIS data and the date that home health agencies will have to begin submitting OASIS data for non-Medicare and non-Medicaid skilled patients. She said the good news is that HCFA is deferring the encoding of personal care only data. According to St. Pierre, the agency implied that it will be two years or more before that information is required.
St. Pierre added that the good news about the new version new data specifications on OASIS is that they will allow agencies to submit information from branch offices rather than from the branch to the parent company and then to the state. But the bad news is that HCFA will implement a "fatal errors" mechanism. "You may be getting a lot of records rejected rather than the warnings that you have been getting up to this point," she warned.
St. Pierre also pointed to a series of changes that will take place concurrently with the PPS regulation. She said that agencies will likely have to beginning sending in data on Medicare and Medicaid as well as non-Medicare and non-Medicaid patients next month. In July, there will be a new version released in addition to a new OASIS revision - OASISb-1 2000 - that will include the requirements to match PPS, she said. HCFA's initial outcomes reports on case-mix and adverse reports are expected late-fall, she added.
St. Pierre also reported that since the release of HCFA's recent CFO audit, agency staff have analyzed where the errors were focused in home health claims. She said HCFA found that 80% of the payment problems for home health were the result of no signed orders and/or no end date for daily visits. As a result, she said the agency now plans to streamline the claims process and improve provider education and contractor oversight.
St. Pierre also reported that HCFA plans to publish a provider enrollment regulation proposed rule that includes a "provider plus" component that would help establish which agencies are performing above and beyond the basic requirements and how to reward those agencies.
According to St. Pierre, HCFA is proceeding as if there is going to be a proposed rule coming out soon for surety bonds. But although there is a draft circulating HHS right now, she said there is strong sentiment at the agency that there are simply too many problems associated with a surety bond regulation.
The regulatory barrage facing home health agencies is coming not only from HCFA but now also from the Occupational Safety and Health Agency (OSHA; Washington), according to St. Pierre. But she said there appears to be strong support on Capitol Hill to have OSHA back off its proposed ergonomics regulation. "We are hoping we won't see an ergonomics rule and if we do see one that it will be scaled way back," she said.
St. Pierre also pointed to the cultural and linguistic guidelines for healthcare providers being developed by the Department of Health and Human Services (HHS; Washington). "These also are very burdensome," she warned. For example, providers would be forced to interpret in any language the patient speaks and could not rely on family members to interpret. But she added that HCFA will translate its own documents, such as the advance beneficiary notice, if it receives a 100 signatures asking it to do so.
Finally, she noted that HCFA is working on guidelines for the prevention of abuse and neglect. "We urged HCFA not to come up with a whole new string of regulations and requirements to prevent abuse and neglect," she said. "There are enough regulations right now on home care agencies to imply that your personnel do not abuse or neglect patients."
St. Pierre also reported that the Joint Commission plans to revamp its entire home care survey process. She said that revision will include standards and fees as well as the entire process and ORYX requirements. "They are working very hard at pursuing this and are getting together an advisory group," she said. "The realize they must make changes quickly in order to have agencies continue to come to them for accreditation."
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