Home Health & Hospice Week

HHA and hospice rates stay intact while bidding gets shelved.

Intense political maneuvering over Congress' July 4th recess resulted in good news for home care providers.

A bill leaving Medicare home health agency and hospice payment rates intact was enacted July 15 after political drama. The new law also delays competitive bidding for durable medical equipment for 18 months.

The controversy over the bill arose due to its cuts to Medicare Advantage plans, which Democrats generally favored and Republicans opposed. The law will cut about $13.5 billion from MA payments over five years. That will reduce MA enrollees from a projected 14.3 million under the former rates to about 12 million, the Congressional Budget Office projects.

The bill also extends therapy cap exceptions for Part B services for 18 months.

HHAs, Hospices Duck Massive Proposed Cuts

The Medicare bill's fate was uncertain after the Senate failed to bring the legislation to a vote before the July 4 recess (see Eli's HCW, Vol. XVII, No. 24,). While passage of some sort of Medicare bill was very likely due to the 10.6 percent cut to physician payment rates that took effect July 1, the home care provisions in the bill remained uncertain.

After the Senate's failure to vote on the bill June 26, the American Medical Association and other physician trade groups leaned hard on Repub-lican senators to approve the bill. Nine Republicans switched their votes from 'no' to 'yes' for cloture, which was also a vote on the bill.

The Senate on July 9 voted 69-30 to approve the legislation, with 18 Republicans ultimately voting for the measure.

President Bush on July 15 vetoed the bill as promised due to the significant MA cuts included. The House and Senate quickly voted to override the veto, enacting HR 6331 into law.

Victory: HHAs and hospices should celebrate the fact that they escaped big cuts proposed by the Bush administration earlier this year. The President wanted to cut HHA spending by $11 billion over five years and hospice rates by $5 billion, points out the National Association for Home Care & Hospice.

Agencies were disappointed not to see the 5 percent rural add-on in the legislation, but the provision may still gain approval this session.

"Passing this bill was absolutely the right and moral thing to do," said Sen. Jay Rockefeller (D-WV) after the vote.

"Millions of Americans can go to sleep tonight knowing that they will be able to get the health care they need," said Senate Finance Committee Chair Max Baucus (D-MT) in a release.

Presumptive Democratic presidential nominee Barack Obama (D-IL) voted for the measure while presumptive Republican nominee John McCain (R-AZ) did not vote, but expresses opposition to the legislation.

"We should not hold our doctors and seniors hostage to political gamesmanship and political votes," McCain told the press. The bill "rolls back important reforms."

Sen. Richard Burr (R-NC) dismissed the vote as "yet another unfortunate display of partisanship." Burr also was "very disappointed this has come at the unnecessary expense of Medicare Ad-vantage," he said in a release.

Next up: HHAs and hospices can't just rest on their laurels for the rest of the legislative session. They need to exhort their representatives to reinstate the 5 percent rural add-on and reverse the hospice cuts proposed by the wage index budget neutrality factor (see Eli's HCW, Vol. XVII, No. 17), NAHC urges.