Heard about HCFA's latest Capitol offense? IPS is still the law
No sign of concessions on surety bond issue, either
The Health Care Financing Administration (HCFA) in Baltimore recently announced it would release revisions to its surety bond requirements for home health and durable medical equipment (DME) providers. The news initially brought a ray of hope, but those revisions seem to have slammed the door shut on providers.
"This makes it slightly more palatable for surety bond companies to offer bonds, but it does nothing for small-business home health agencies," says Ann Howard, executive director of the American Federation of Home Health Agencies (AFHHA) in Silver Spring, MD.
There were no revisions made for DME requirements (see Home Infusion Therapy Management, March 1998, p. 25; April 1998, p. 37), and those made to the home health requirements fell far short of industry hopes. The changes will:
· Limit liability to the bond in effect when it is determined that funds are owed to Medicare, regardless of when the overpayment or misdeed took place.
· Establish that bond writers have liability for an additional two years when a home health agency leaves the Medicare program.
· Give bond companies the right to appeal overpayment assessments if an agency fails to assign its right of appeal to the company.
The heavy emphasis on appeasing bond companies rather than providers leaves three methods by which the surety bond requirements can be revised, says Howard. Those are:
· HCFA sees the error in its ways and makes it a $50,000 bond for new agencies.
· A court throws out the surety bond requirement as written by HCFA.
· Congress steps in and makes it a $50,000 or $25,000 bond.
Howard notes that there is a legislation in the anti-fraud and abuse legislation for home health that proposes to drop the surety bond requirement to a $25,000 one-time bond for new agencies.
"At this point I don't know anyone in Congress who believes that what the administration has done with home health surety bonds is worthy of support," notes Howard. "It's a matter of inspiring people to take the action necessary." If the requirements remain as currently written, the nation could be in for a crisis, according to Howard.
"HCFA's surety bond regs indicate absolute contempt for home care, home care patients, the Small Business Administration, and the people in Congress who have been saying current surety bond regulations are unworkable," she says. "As the bonds are now, I would say 80% of small-business home health agencies won't be able to get them."
Meanwhile, back in DC . . .
HCFA also is working on a one-two punch with its Interim Payment System (IPS).
"If [the IPS] isn't fixed, it's the other nail in the coffin," says Howard. "There are certain things HCFA could have done to alleviate the process, such as allowing newer home health agencies a regional per patient cap rather than a national median, and there are other areas where they had discretion, but they erred on the side of the most draconian approach they could."
AFHHA is hopeful that, as with the surety bond dilemma, either Congress or the courts will come to the rescue. "We're hopeful one of the court cases will throw it out, and there is the congressional route," notes Howard.
However, even though there seems to be concern on Capitol Hill, concern and action are two separate issues. "Congress is beginning to hear from agencies and the pain is just starting to show," says Howard. "My concern is that there are a lot of people in Congress who are concerned, but would rather not do anything because it's hard."
Alan Parver, JD, president of the Washington, DC-based National Alliance for Infusion Therapy, notes that the House recently approved a budget resolution that included no Medicare cuts, which is in line with the previously passed Senate budget resolution that also had no such cuts. "It's very unlikely now there will be a reconciliation bill that will require Medicare reductions," notes Parver. "It looks like there may be a health bill that addresses patient rights and managed care issues, and some of those provisions might have an effect on providers."
Parver notes that there is not much time left in the 1998 session, as Congress plans to take most of August off and hopes to end the session by mid-October. While Parver cautions against writing off 1998, he notes there will likely be a carryover of legislation into next year, leading to a potentially active 1999.
"There is the continuing debate for Medicare payment for outpatient drugs, and that's going to continue into 1999," notes Parver. "So much has gone into implementing the Balanced Budget Act that 1999 is probably going to be a pretty major year in terms of Medicare legislation. There will be further structural changes, and there will be efforts to reduce expenditures, so 1999 should be a much more active year than this."
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