No clear path yet on Medicare budget for home healthcare
By MATTHEW HAY
HHBR Washington Correspondent
WASHINGTON The next fork in the road for home health Medicare spending may be hearings before the Senate Finance Committee next month. The Senate Finance Committee told home health representatives it will likely hold hearings with various providers on Medicare payment issues in June after the Medicare Payment Advisory Commission (MedPAC; Washington) issues its next report.
It is still unclear how the budget reconciliation process will unfold, however. "Presumably, the Finance Committee will have to draw up a plan for Medicare spending," said the National Association for Home Care’s (NAHC; Washington) Jeff Kincheloe. "But every year, Congress seems to come up with an abnormal process that ends up tacking various entitlement issues on appropriations bills."
Legislation introduced in the House and Senate last month the Home Health Payment Fairness Act would eliminate the 15% reduction in Medicare home health payments, and that bill has attracted a growing list of co-sponsors in both chambers. But Kincheloe said that while there is growing support in Congress for eliminating the additional 15% cut slated for next year, passing legislation that seals that commitment is still the industry’s top priority.
Despite the growing sentiment that an additional cut in home health reimbursement would be excessive, Congress must find an offset somewhere else in the budget. Kincheloe warned that home health will be competing with other healthcare providers for the $40 billion that was set aside by Congress for Medicare reform and prescription drug coverage.
Meanwhile, two bills were also introduced that would address the homebound criteria used by the Health Care Financing Administration (HCFA; Baltimore) to determine eligibility. Sens. James Jeffords (R-VT) and Jack Reed (D-RI) introduced the Homebound Clarification Act last month. The bill would eliminate the current requirement that absences from the home be infrequent or of relatively short duration. But the consensus is that that bill faces long odds
Legislation was also introduced in the House that would permit Medicare beneficiaries with Alzheimer’s to attend adult day care without jeopardizing their home health benefits. The Alzheimer’s Disease Medicare Home Health Care Benefit Clarification Act of 2000 was introduced by Reps. Christopher Smith (R-NJ) and Edward Markey (D-MA).
In addition, the leaders of the Home Health Working Group are circulating a "Dear Colleague" letter to members of the Rural Health Care Coalition asking them to urge HCFA to release the prospective payment system (PPS) base rate and disclose the budget neutrality factor.
Rep. David Vitter (R-LA) has written a separate letter to HCFA Administrator Nancy Ann DeParle demanding release of the PPS base rate. Vitter argues that there is not enough time between final rule, including the base rate in July and implementation of the new system in October, for agencies to make the necessary changes.
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