Home Health & Hospice Week

More than 40% of HHAs will be under water on Medicare this year, trade group says.

President Obama has released his budget proposal for 2015, and home care providers aren’t going to like it.

Like last year, the Obama Administration proposes a copayment for Medicare home health agency services. It also floats a 1.1 percent reimbursement rate cut for HHAs. Those are on top of already existing cuts, including the 14 percent rebasing reduction over four years.

"Medicare reforms should never be funded by making indiscriminate across-the-board cuts to home health care or by shifting costs to our most vulnerable citizens through copays," says the Na-tional Association for Home Care & Hospice.

"Previously enacted changes will cut Medi-care spending on home health services by more than $100 billion over the next ten years — while less than $20 billion is spent each year. As a result of these cuts, Medicare will pay home health agencies less than their costs, meaning that 41 percent of all Medicare home health agencies will be under water in 2014, and 60 percent by 2017," says NAHC’s Val J. Halamandaris. "Congress should therefore reject any additional cuts and any home health copay whether the reason is postponement or elimination of scheduled cuts in physician fees or deficit reduction."

The copay would take effect in 2018. The budget proposal also prioritizes bundling amongst post-acute providers, points out the Visiting Nurse Associations of America.

These cuts may become part of the fund to pay for the so-called "doc fix" bill that will avert the pay cut scheduled for March 31 under physicians’ sustainable growth rate (SGR) Medicare payment formula, observers worry. But lawmakers don’t want to fund the SGR fix with unpopular Medicare cuts, so they are dragging their feet on the issue.

Reminder: In HR 4015, the SGR would initially be "fixed" by repealing the current formula (which creates a large Medicare payment decrease every year) and replacing it with a 0.5 percent update every year until 2018.

Don’t Forget About Therapy Caps

Also: HR 4015 currently contains no language to repeal the therapy caps, which affect Part B outpatient therapy furnished by home health agencies in the patient’s home. Therapy industry experts had expected otherwise since the Senate committee’s original version of the bill included this provision.

Cutting it close: Like the current doc fix, therapy cap exceptions are set to expire March 31. If Congress produces no solution by this time, agencies providing Part B therapy will face full-on therapy caps with no exceptions.

"While we are disappointed that the SGR reform bill does not include repeal of the therapy caps, we remain hopeful that Congress will address therapy caps in the final bill," says Ingrida Lusis of the American Speech-Language Hearing Association.

"Few policy options in Congress today enjoy the broad, bipartisan support of therapy cap repeal," points out Tim Casey of the Occupational Therapy Association.