Sens. Bond, Collins introduce sweeping home care reform bill
Sens. Bond, Collins introduce sweeping home care reform bill
By MATTHEW HAY
HHBR Washington Correspondent
WASHINGTON Two influential senators, Kit Bond (R-MO) and Susan Collins (R-ME), last week introduced the most sweeping home health reform bill Congress has seen yet. The Home Health Equity Act of 1999 includes eight major provisions designed to roll back significant pieces of the Balanced Budget Act of 1997 (BBA), including elimination of the automatic 15% reduction in Medicare home health payments scheduled for Oct. 1, 2000. Under the BBA, that reduction will take place whether a home health prospective payment system (PPS) is implemented according to schedule.
The Bond-Collins bill, which includes many of the provisions in a bill introduced a week earlier in the House by Rep. Bill Coyne (D-PA), immediately became the front-runner in the Senate. Bond is chairman of the Senate Small Business Committee and has a demonstrated ability to marshal support for home care initiatives. Collins chairs the Senate Permanent Committee on Investigations and has used that podium to spotlight problems in the home care industry.
But just as important as what the Bond-Collins bill does is what it doesn’t do, namely split the industry by targeting high-cost or low-cost agencies for relief. "It was very important not to open up that can of worms," said one industry representative.
Bond and Collins noted that when it was enacted, the Congressional Budget Office (CBO) reported that the BBA would reduce home health expenditures by $16.1 billion between FY98 and FY02. But the CBO’s latest estimate says that number will approach $48 billion — three times the anticipated budgetary impact. "A further 15% cut to home health costs limits would be devastating to cost-efficient providers and would reduce seniors’ access to care," the CBO said. "Moreover, it is unnecessary since the budget target for home health outlays will be achieved, if not exceeded, without it."
The Bond-Collins bill would also provide supplemental "outlier" payments to home health agencies on a patient-by-patient basis if the cost of care for an individual is considered by the Secretary of Health and Human Services (Washington) to be "significantly higher than average" due to the patient’s particular health and functional condition. According to Bond and Collins, this would remove the existing financial disincentives under the IPS for agencies to care for these patients.
The bill would increase the per-beneficiary cost limit for agencies with limits below the national average by gradually raising low-cost agencies’ per-beneficiary limits up to the national average over three years or until the home health PPS is implemented. It would also increase the per-visit cost limit from the current 106% of the median to 108% of the national median. According to Bond and Collins, the rapid growth of home health in the last decade was fueled by the high number of visits to patients rather than the cost per visit. "To decrease total costs in order to remain under the per-beneficiary limits, agencies have had to significantly reduce the number of visits to patients, which has in turn increased the cost of each visit," they said.
The Home Health Equity Act would also revise the surety bond requirement for home health agencies by making it strictly a fraud bond. According to Bond, who spearheaded last year’s effort to postpone the original surety bond regulation issued by the Health Care Financing Administration (HCFA; Baltimore), the main problem with that requirement is that it went beyond congressional intent by attempting to use it as a tool to recover overpayments instead of only targeting fraudulent payments. HCFA now says the revised regulation will not be out until Oct. 1, 2000.
The bill would also extend the IPS overpayment recoupment period for three years without interest. More than a year after implementation of IPS, note the authors, HCFA’s fiscal intermediaries (FI) had failed to notify many agencies of the visit and per-beneficiary limits they faced and instead continued to pay agencies under the previous year’s limits. While HCFA has instructed FIs to extend the repayment period for these overpayments over 12 months, Bond maintains that is insufficient, especially for smaller agencies that lack large cash reserves.
Notably, the legislation would also eliminate the controversial 15-minute reporting requirement. The authors say HCFA’s instructions implementing this BBA provision are "excessively labor-intensive" and would be addressed within the context of the home health PPS.
Finally, the legislation would extend the Periodic Interim Payment Program (PIP), which is currently scheduled to be eliminated Oct. 1, 2000, through the first year of implementation of PPS. That program permits HCFA to make payments to agencies based on historical payment levels prior to the final settlement of claims and cost reports.
Another major but less comprehensive home care bill is expected to be introduced by Senate Health, Education and Labor Chairman Jim Jeffords (R-VT) this summer. That bill would also eliminate the 15% cut and create an outlier policy for high-cost, medically complex patients. It now seems all but certain those two provisions will be included in whatever home care bill is passed by Congress this year.
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