Home Health & Hospice Week

The outcome of the health care reform debate on Capitol Hill is still far from certain, but home care providers are doing their darndest to make sure they aren't slighted in forthcoming legislation.

Senate lawmakers had hoped to have a health care reform bill proposed before July 4th recess, but lawmakers -- both between and in the same parties -- haven't yet come to agreement on legislation.

Three committees in the House have already released their bill, which represents the views of Democratic members. And the Senate Health, Education, Labor, and Pension (HELP) Committee released its ideas in a series of whitepapers and is in the process of marking up its bill.

The Senate Finance Committee, which is working with a bipartisan group of senators led by Chair Max Baucus (D-Mont.) and Ranking Member Charles Grassley (R-Iowa), hasn't been able to come to agreement yet on its health care reform bill, although Baucus did recently celebrate that its overall cost was less than $1 trillion over 10 years as scored by the Congressional Budget Office. Many observers expect the bipartisan approach from Senate Finance to have the best chance of ultimate overall passage.

The House draft is the most punishing so far for home care providers, notes the National Association for Home Care & Hospice. It adopts all of the home health agency and hospice cuts the Medicare Payment Advisory Commission has proposed for the industry (see Eli's Home Care Week, Vol. XVIII, No. 23, p. 180).

The Senate HELP committee bill doesn't contain any Medicare cuts, because it doesn't have jurisdiction over the program. Home care cuts reportedly being considered by Senate Finance would be about $20 billion less than those put forward in the House Tri-Committee bill, NAHC says.

"All of us favor health care reform that would extend health coverage to all Americans," NAHC's Val Halamandaris says in the trade group's newsletter for members. "But ... it must not come at the expense of the nation's most vulnerable citizens who suffer from complex medical problems and are so sick they cannot leave home without assistance."

More ideas: Meanwhile, lawmakers continue to introduce legislation and ideas to influence the health care debate. For example, 24 senators recently signed onto a "Dear Colleague" letter opposing HHA cuts, NAHC notes. And 44 senators signed a letter to President Obama urging him to eliminate budget neutrality adjustment factor (BNAF) cuts for hospices.

Lawmakers from New York have introduced legislation to extend Medicaid spousal impoverishment protections to home care settings, reports the Home Care Association of New York State. And Reps Tim Walz (D-Minn.) and Ginny Brown-Waite (R-Fla.) have introduced H.R. 3030, the "Fostering Independence Through Technology (FITT) Act," which would boost telehealth by creating a pilot program that would provide incentives for HHAs to use home monitoring and communications technologies, NAHC points out.

Unfortunately for home care, multiple sources including Obama budget chief Peter Orszag are getting behind the idea of making MedPAC its own authoritative body with control over Medicare payment rates, rather than its current advisory body to Congress status.

Making your voice heard: The furious health care debate has brought attention to lobbyists for health care providers and other industry players.

In a new series examining lobbyists' influence, National Public Radio noted that $1.4 million per day has been spent in 2009 on health care lobbying and the number of registered lobbyists for health care-related organizations has doubled since 1998 to more than 3,600.

Small providers have to take pains to raise their profiles with lawmakers because they are "small dogs in a big fight," noted a lobbyist for the American Chiropractic Association.