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Home Health & Hospice Week

Industry Notes:

Copay Looms In Medicare Legislation

Published on Thu Oct 16, 2003

A copayment for home health is looking more and more likely.

Lawmakers negotiating the compromise between the House and Senate Medicare legislation are leaning toward implementing the copay as proposed in the House bill, reports The New York Times. The copay would equal about 1.5 percent of an episode's payment, around $45, the Times says.

Industry representatives argue that intensive communication from home care providers still can persuade legislators to forego the copay this year. And many lawmakers already are on record opposing the copay, they add.

At press time, conferees were working doggedly toward their self-imposed Oct. 17 deadline for an agreement, but observers doubted the deadline would be met except in the broadest terms. Lawmakers still are far apart on some key sections of the prescription drug provisions in the measure.

  • The Medicare Payment Advisory Commission will look into whether Medicare home health payments are adequate, staffers revealed in an Oct. 10 meeting. The advisory body to Congress will examine beneficiary access to home care, the rate of agency exit and entry, and access to capital.

    MedPAC staffers plan to estimate current costs versus payments for the analysis, which will be included in the commission's annual report to Congress in March.

  • The HHS Office of Inspector General has issued three more reports criticizing states' Medicaid drug rebate procedures. The OIG found fault with the drug rebate programs of Ohio, Wisconsin and Michigan. Wisconsin and Ohio maintained that at least some of their disputed policies were in compliance, while Michigan concurred with the OIG's findings.

  • In the wake of Operation Wheeler Dealer's crackdown on power wheelchairs and scooters, Hoveround Corp. has announced an agreement with rehab chain HealthSouth Corp. to perform mobility assessment evaluations on Hoveround's clients. "The evaluations are designed to ensure that each client's functional level is compliant with medical guidelines," Sarasota, FL-based Hoveround says in a release.

    Licensed physical or occupational therapists for Birmingham, AL-based HealthSouth will conduct functional testing and a detailed medical interview. HealthSouth, with 1,700 locations, is currently undergoing a highly publicized health and securities fraud investigation.

  • Heads have rolled at Option Care Inc. as a result of sagging earnings. The Buffalo Grove, IL-based infusion and specialty pharmacy company says it won't meet analysts' estimates for the quarter ending Sept. 30 or its own year-end guidance as a result of lower-than-expected sales. CEO Raj Rai says the lower sales are due in part to sluggish hospital admissions, shorter infusion therapy duration and uncertainty surrounding pending Medicare legislation that would lower Medicare's reimbursement rates for drugs, particularly oncology drugs.

    To combat the depressed sales figures, Option Care has restructured, including eliminating a number of positions from field administrators to corporate infrastructure, it says. The company is also revamping its sales program and renegotiating unfavorable managed care contracts.

  • Home Care Supply has acquired Meridian Health Services of Clearwater, FL for an undisclosed amount, the Beaumont, TX-based home medical equipment company says. Meridian has revenues of $1.5 million and "outstanding growth ... in the respiratory area," HCS says.

    HCS says it is the largest privately held HME company in the nation, with 60 locations in 13 states.

  • Disease management company Matria Healthcare Inc. has been busy. In the span of five days, Marietta, GA-based Matria has announced 17 new disease management accounts, an acquisition, and the opening of a new call center.

    Of the 17 new DM accounts to go into effect in the end of 2003 and beginning of 2004, 12 are with large self-insured employers and five are with health plans or third-party administrators.

    Matria's acquisition involved Huntington, NY-based Options Unlimited, a 20-year-old, privately held company that furnishes case management services for chronic, complex and catastrophic medical conditions via 150 consultants nationwide.

    Finally, Matria subsidiary Quality Oncology Inc. has opened a new cancer support call center in Houston, TX.

  • Tennessee's pilot project for Medicaid home care services may not be as comprehensive as advocates would like, but it's a start. The Tenn-Care Bureau is constructing a home care pilot program following federal court approval of a related lawsuit (see Eli's HCW, Vol. XII, No. 36, p. 286).

    All the pilot's details haven't been worked out yet, but it's pretty clear the $1.2 billion project will apply to only part of the state, reports the Chattanooga Times Free Press. "We don't yet have the capacity to deliver the services in the way we would like right now. You can't simply start up across the state," a state official told the paper.

  • The picture is looking grim for two more states' home care programs. Georgia is looking to cut $21 million in health care costs from its budget this year and $141 million next year, and home care is one of the services under the ax. Among other things, home therapy visits, now limited to 75 visits per year, would be scaled back to 50, reports the Associated Press.

    And a Florida state budget shortfall is lengthening the wait list for Medicaid home care services, reports the Vero Beach, FL Press Journal. As a result, the Indian River County Agency on Aging has cut back staff. No one has been able to enroll for waiver personal care services in the county since late 2002, the paper says.

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