Home Health & Hospice Week

But rural add-on for HHAs could actually succeed in a new Medicare bill.

Political posturing in Washington, DC is holding up pending Medicare legislation, leaving home care providers on pins and needles as reimbursement cuts threaten.

Safe: In Medicare budget negotiations, there's always a chance that lawmakers can slip in last-minute cuts to providers' rates in pending legislation. But at press time, it looked as though home health agencies and hospices wouldn't suffer any cuts under the two proposed Medicare bills.

And HHAs could even benefit by the reinstatement of the 5 percent rural add-on called for in one of the bills. That's "an exciting development for rural home health agencies and patients in rural areas," cheers the National Association for Home Care & Hospice.

At risk: Oxygen and wheelchair suppliers are both under the threat of budget cuts in the pending legislation.

Senate Finance Committee Chair Max Baucus (D-MT) introduced legislation earlier this month calling to eliminate the first-month purchase option for standard power wheelchairs and to reduce and revamp power wheelchair payments (see Eli's HCW, Vol. XVII, No. 21). S. 3101 also proposes oxygen payment cuts.

On June 11, Senate Finance ranking member Charles Grassley (R-IA) proposed a competing Medicare bill that "does not make cuts to payments for power wheelchairs" and "does not reduce payments for oxygen," Grassley pledged.

"This plan will not cut payments to those using power wheelchairs or those dependent on oxygen," stressed Senate Finance Republican member Mike Crapo (ID) in a release.

Grassley's bill goes a step further by proposing a repeal of the 36-month capped rental period for oxygen, NAHC notes.Grassley's bill also calls for the 5 percent rural add-on for HHAs. S. 3118 "goes further to ensure that Medicare beneficiaries continue to have access to quality care, especially those in rural areas," maintains Sen. Jim Inhofe (R-OK).

MA Plan Cuts A Sticking Point

Baucus tried to get his bill to the Senate floor for a vote June 12, but it was blocked by a failed cloture vote of 54-39.

That means Democrats and Republicans, who broke off negotiations over the bill last month, must come back to the negotiating table as the clock ticks toward the Medicare physician pay cut.

Both Baucus' and Grassley's bills call for averting the 10 percent cut to physicians' Medicare rates scheduled for July 1. But Baucus' bill calls for extra Medicare provisions that bring the bill's total price tag to about $20 billion. Grassley's narrower legislation carries a price tag of $15 to $16 billion, in comparison.

Baucus' bill would raise funds mainly from cuts to Medicare Advantage plans' Medicare payment rates, while Grassley's would get the funding from hospital and other cuts.

Other provisions: Both bills call for ex-tending Part B outpatient therapy caps. And Grassley's bill calls for an Institute of Medicine report on post-acute care.

Hospice foreshadowing: While hospices look like they'll escape this year's budget process unscathed, the same might not be true next year. After the Medicare Payment Advisory Commission's criticism of hospice profit margins and other payment elements this year, both bills call for more MedPAC examination of Medicare hospice payment rates, including the hospice caps.

What to expect: Sen. Baucus is expressing confidence that Congress can pass a Medicare bill averting the doc pay cut before June 30, but observers aren't so sure about that pledge. Democrats and Republicans will have to come to an agreement on and pass a bill in a remarkably short period of time for that to occur.

"There are a number of steps left to go in the political process, each one inherently somewhat unpredictable," cautions Bob Wardwell with the Visiting Nurse Associations of America. "It's never over until it is over, and then there is next year," Wardwell tells Eli.