Home Health & Hospice Week

Home care rates aren't sure until the President signs a Medicare bill.

The delay to Medicare budget legislation is putting home health agency, hospice and durable medical equipment reimbursement at risk, but also giving HHAs a second chance at increased funding.

On June 24, the House of Representatives passed Medicare budget legislation by a wide veto-proof majority. The bill, H.R. 6331, would have averted a 10 percent cut to physician payments slated for July 1 (see Eli's HCW, Vol. XVII, No. 23).

The Senate was widely expected to follow suit in approving the bill before Congress' July 4th recess. But instead, on June 26, Senators failed to agree to bring the Medicare budget bill to a vote. The vote was 58-40 against cloture.

Even if the Senate had agreed to vote on the bill, it would have had to approve it with 67 votes to head off a threatened veto from President Bush. The Bush administration opposes the bill because it relies largely on Medicare Advantage cuts to fund the fix to physician payment.

The Senate vote touched off a round of political infighting. Democrats accused Republicans of torpedoing the physician pay solution while Republicans accused Democrats of trying to muscle through a biased bill devoid of bipartisan support.

Meanwhile, Health and Human Services Secretary Mike Leavitt announced that the Centers for Medicare & Medicaid Services would hold physician claims until July 15 to give Congress a chance to resolve the payment issue. The hold applies only to claims with services furnished July 1 or later, Leavitt clarifies in a statement.

Bill's Final Provisions A Question Mark

The Senate will most likely approve a Medicare bill after it reconvenes July 7, but no one can agree on what form the bill will take.

Senate Majority Leader Harry Reid (D-NV) has been telling the press he will reintroduce the same House bill that failed to garner support in the most recent vote. The outcome could change because lobbyists such as the American Medical Association are putting pressure on Republican senators to change their votes on the bill.

That bill leaves HHA and hospice updates intact for 2008 and 2009, delays competitive bidding by 18 months in exchange for a 9.5 percent cut to bid item rates, and does not include earlier proposed cuts to oxygen and wheelchair payment rates.

Down side: If this bill comes back up for a vote unchanged, it will give HHAs no chance to secure reinstatement of the 5 percent rural add-on.

The Senate may also choose to take up a compromise bill between the House and Senate versions, most likely crafted by Senate Finance Chair Max Baucus (D-MT) and ranking member Charles Grassley (R-IA). The bill, which probably would significantly scale back managed care cuts, would give HHAs another crack at obtaining the rural add-on, but could contain oxygen and wheelchair cuts. Bidding's fate is also uncertain in such legislation.

Or members of Congress could let the phy-sician payment cut go into effect and take longer to hammer out a different Medicare budget bill. The bill would almost certainly contain a retroactive restoration to physician payments.

The National Association for Home Care & Hospice expects HHA and hospice payments to re-main safe in Medicare legislation, it notes in its newsletter. The bidding delay also still has a chance of making it into the bill, NAHC predicts.

"I think we're safe on home health and hospice," agrees Kathy Thompson with the Visiting Nurse Associations of America. "But it's a long shot on the rural add-on," Thompson tells Eli.