Home Health & Hospice Week

Plus: HHAs breathe sigh of relief over doc fix.

Will home health agencies have the juice to fight off another copayment proposal this legislative session? The battle just got tougher, thanks to Presi-dent Obama's 2013 budget proposal.

The Medicare Payment Advisory Com-mission is reissuing its proposal for a home health episode copay in its report to Congress next month, and now the president has added his voice to the call for a copay.

The details: In the president's 2013 budget proposal, the White House floats a $100 per episode copay for non-LUPA episodes that are not preceded by an inpatient facility stay. The copay that would start in 2017 and apply to new beneficiaries would strip $350 million from Medicare home health spending over 10 years, according to the budget proposal. The $100 per episode amount is "modest," the proposal maintains.

Plus: The president also says he supports "adjustments" to post-acute provider payments, including those for HHAs, to "encourage efficient post acute care." Adjustments across the spectrum of post-acute providers, including SNFs and IRFs, would cut Medicare spending by $63 billion over 10 years, according to the budget proposal.

And the budget calls for inflation updates to be reduced by 1.1 percent from 2014 to 2021 for post-acute providers including HHAs, points out the National Association for Home Care & Hospice. "These reductions would be in addition to the 2014 home health rate rebasing and the productivity adjustments starting in 2015," NAHC says.

Loophole: "The proposal indicates that the payment update would not drop below zero," NAHC points out. "If that standard is applied, HHAs would face no cuts during the rebasing period since rebasing is very likely to bring the annual update to zero or below in 2014-2017 with an additional cut coming with an annual productivity adjustment (estimated about 1 percentage point) starting in 2015."

The budget contains no specific references to hospices.

Industry trade groups have come out swinging against the copay proposal. Visiting Nurse Associations of America members "are very concerned that any copay will lead patients to skip much-needed home health assistance, causing them to end up back in the hospital or another institutional setting at a much greater costs to themselves and to the Medicare program," VNAA's Andy Carter says in a release. "Now is not the time to create barriers to Medicare home health services, which allow patients to receive high quality care at home and not have to be institutionalized where costs and health care risks are much higher."

"Essential home health services are at risk," NAHC warns in a release. "The Medicare home care benefit, only $17 billion in 2009, has been cut by $77 billion over the next 10 years."

Try this: "Instead of across-the-board Med-icare cuts or mandatory copayments for low-income seniors, the home healthcare community believes that Washington should focus on strengthening Medicare and Medicaid through program integrity reform," says industry lobbying group the Partner-ship for Quality Home Healthcare. "Analyses of Medicare data show that targeting the small number of providers who bill outside national norms would significantly reduce annual Medicare spending."

Program integrity reform "generates billions in savings without harming innocent seniors or cost-efficient providers," Billy Tauzin, former House Energy and Commerce Committee chair and senior counsel to the Partnership for Quality Home Health-care, says in a release.

Congress should not ask "our nation's sickest and poorest seniors to shoulder the burden of an expensive copayment, which many patients simply cannot afford," former Sen. John Breaux (D-LA) says in the release.

State governors have complained that a home health copay will push beneficiaries into nursing homes and thus increase Medicaid spending, the Partnership adds.

Meanwhile, HHAs are breathing a sigh of relief that lawmakers don't appear to be raiding their Medicare payments to avert the 27 percent cut to physician payments set to take effect March 1. A House-Senate conference has agreed on a "doc fix" plan that will postpone the physician cuts until Jan. 1, 2013, according to news reports.

Funding would come from a mix of sources including hospital and nursing home bed debt payments, the health care fraud fighting budget, clinical lab reimbursement, and Medicaid funding. A vote on the measure, which is included in legislation with the payroll tax cut extension, is expected shortly.

Note: The president's budget proposal is at http://www.whitehouse.gov/sites/default/files/omb/budget/fy2013/assets/budget.pdf.