Bipartisan Commission ready to recommend 10% copay
Bipartisan Commission ready to recommend 10% copay
By MATTHEW HAY
HHBR Washington Correspondent
WASHINGTON The National Bipartisan Commission on the Future of Medicare appears poised to recommend a 10% copayment for home health care. That proposal was included in a plan developed by the Commission’s co-Chairman Sen. John Breaux (D-LA). The Commission’s final report is already overdue and any final consensus will be hard to reach because of the requirement for an 11 vote "supermajority" of the Commission’s 18 members. But home care representatives fear the copay provision might find favor with the Commission’s other co-Chairman, Rep. Bill Thomas (R-CA), who leveled sharp criticism at the industry throughout last year’s battle over the final shape of the interim payment system (IPS).
Breaux’s proposal would hit skilled nursing facilities (SNF) the hardest. A House Ways and Means aide close to the process said the last proposal floated by Breaux included a 10% copay for home health care and 20% copay for the first 20 days in a SNF. The 10% figure would translate into roughly a $5 copay for home health and a $9 to $11 copay for skilled nursing.
Breaux’s proposal comes in the wake of the Medicare Payment Advisory Commission’s (MedPAC; Wash ington) formal recommendation to Congress to impose a copay on home health visits. It was included in MedPAC’s Annual Report to Congress released March 1.
The home care industry found some solace in a groundswell of opposition to the copay led by Rep. Bernard Sanders (I-VT). In a letter signed by 69 of his colleagues last week, Sanders told Breaux and Thomas that the 10% copay proposal would cause "enormous pain and hardship for low-income and sick and elderly people."
According to HCFA’s most recent data, the average per beneficiary reimbursement for home health care was $4,074 in 1997, noted Sanders. "A 10% copayment would mean the average Medicare beneficiary would have to pay $470 out-of-pocket per year for home health services," he argued, even though nearly half of all seniors have incomes below $15,000 a year.
While the commission won’t offer any formal legislation, Thomas and Breaux said they don’t feel bound by the commission’s recommendations. One House aide told HHBR, Breaux discounted the importance of achieving the support of a "supermajority" on the commission because he has the support of 11 of his fellow members of the Senate Finance Committee. "He’s right," predicted the House aide. "It will probably pass out of Senate Finance 15 to 5."
NAHC’s Bill Dombi said that the commission’s final plan is undergoing significant changes as various factions search for the elusive 11th vote. He also said that the commission’s plan has no defined benefit package and eligibility requirements are still up in the air. But Dombi agreed that Thomas and Breaux will introduce their own Medicare reform bills.
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