Home Health & Hospice Week

Last-minute legislation also addresses recovery audits, wage index, respite care.

Home health agencies that furnish outpatient Part B therapy won't have to apply therapy caps to all patients in 2007.

In addition to leaving home care payment rates untouched for next year in the bill passed Dec. 8 and 9 (see Eli's HCW, Vol. XV, No. 44), Congress extended the exceptions process to the $1,780 cap on outpatient therapy. The caps don't apply to therapy furnished under a home health plan of care.

To qualify for the automatic exception to the therapy cap, patients must have one of the diagnosis codes the Centers for Medicare & Medicaid Services lists in Feb. 15, 2006 Transmittal No. 855. (For more information on how to qualify patients and bill for the exception, see Eli's HCW, Vol. XV, No. 9.)

Audit alert: HHAs' reprieve from Recovery Audit Contractors may be coming to an end. CMS excluded agencies from the RAC demonstration that began this year, although durable medical equipment providers were still included (see Eli's HCW, Vol. XV, No. 17). The bill, the Tax Relief and Health Care Act of 2006, expands the RAC program to all states.

However, RACs are unlikely to focus on HHAs any time soon, experts tell Eli. That's because RACs are more likely to spend resources auditing big-ticket claims such as those for hospitals, they predict.

Report coming: The bill also requires the Medicare Payment Advisory Commission to issue a report evaluating the wage index. The report due in June 2007 will include possible alternatives on ways to compute the wage index, says the Connecticut Association for Home Care.

"CAHC has been advocating for revisions to the calculation of the Medicare wage index ... and welcomes this turn of events," the trade group says in its newsletter. "We are pleased that Congress has expressed its intent that wage index reform should be explored in all health care settings, not only hospitals."

A summary of the health provisions of the bill is at http://waysandmeans.house.gov/media/pdf/taxdocs/hr6408healthsummary.pdf.

Caregiver support: Congress also authorized a bill that would establish a federal program for respite care for individuals who provide long-term care for relatives, according to press reports. And the bill would provide for grants to statewide respite care service providers. • Sen. Harry Reid (D-NV) is getting flack for helping a Nevada hospice in the budget bill. Reid and Sen. John Ensign (R-NV) secured inclusion of a provision granting satellite status to the Pahrump office of the Nathan Adelson Hospice of Las Vegas, according to a release from Reid. The then-Health Care Financing Administration denied the location satellite status back in 1999. NAH appealed but got no response from HCFA, the release says.

CMS granted the satellite status in 2005, but sought overpayments [...]