Home Health & Hospice Week

Don't get too comfortable with 2008 rates.

Home health agencies aren't happy that the PPS refinements final rule cuts Medicare payment rates by 2.75 percent for supposed case mix creep. But another cut just as big still threatens HHAs' reimbursement.

That's because Congress is back in session and is considering legislation to eliminate the market basket increase to HHA rates for 2008. The inflation update is usually around 3 percent.

In August, the House passed a bill that would extend and expand the State Children's Health Insurance Program (SCHIP). The bill also had Medicare provisions, including a freeze on HHA payment rates (see Eli's HCW, Vol. XVI, No. 28) and cuts to oxygen and wheelchair reimbursement. A SCHIP bill the Senate passed had no Medicare provisions.

Capitol Hill insiders say the House is considering dropping the Medicare parts of the legislation to advance the SCHIP issue and come to a compromise with the Senate. But that rumor has brought out heavy lobbying from the American Medical Association, other physicians' groups and the AARP. They want the reversal of the 10 percent cut to physicians' payments, included in the House legislation, to take place.

Home care providers have some heavy-hitting lobbyists on their side as well. Nursing home groups and managed care plans are both pushing for the SCHIP bill that contains no Medicare provisions, since those groups also would see cuts under the House bill.

Home Care Providers Battle Legislation

Home health agencies participated in the National Association for Home Care & Hospice's "March on Washington" lobby day Sept. 10. Agencies from 45 states took part in the activity, says a NAHC spokesperson.

"It is imperative that home care's voice be heard," NAHC says. The trade group will hold more "virtual" lobbying days Sept. 18 and Oct. 9, it adds.

Home medical equipment providers were successful during the Congressional recess with a campaign to host members of Congress on their own turf, reports the American Association for Homecare.

Patrick Hanna of B&K Home Medical Services hosted a media-covered site visit with Rep. Paul Gillmor (R-OH) in Tiffin. More site visits in Ohio are planned, says Kam Yuricich of the Ohio Association of Medical Equipment Services.

The oxygen and power wheelchair cuts proposed in the House version of the SCHIP bill have been raised in congressional meetings and have generated local press in Alabama, Pennsylvania, and Ohio, among other states, according to AAHomecare.

Timeline: The legislative session is scheduled to end Oct. 1, but often runs over. HHAs may not learn their final 2008 payment rates until the end of the year. They could even see retroactive reductions to the rates, such as occurred for 2006 rates.

• President Bush has named CMS Administrator nominee Kerry Weems as CMS Acting Administrator, according to press reports. The position has been vacant since CMS Acting Administrator Leslie Norwalk stepped down in July.

Bush appointed Weems, whom he nominated for the permanent post in May, because the Senate has not scheduled a vote to confirm the nomination. Weems could remain in the acting role until Bush leaves office, speculates The Hill newspaper.

• At last you can look up the National Provider Identifiers (NPIs) of doctors who send patients to you. The lookup is available online at https://nppes.cms.hhs.gov/NPPES/NPIRegistryHome.do.

• Connecticut agencies with patients in rural areas have received some good news. The Centers for Medicare & Medicaid Services improperly included one county in the rural wage index calculation for the state, reports the Connecticut Association for Home Care. CMS will publish a technical correction to the final rule that will put the rural wage index for the state at about 1.17, up from the 1.12 published in the final rule, the trade group says in its newsletter to members.

• Now might be a good time to make sure the hospice care you furnish is covered. Regional home health intermediary Palmetto GBA is revamping some hospice local coverage determinations (LCDs). Palmetto has revised hospice LCDs on adult failure to thrive syndrome, pulmonary disease and heart disease, according to an email it sent providers.

Palmetto also tweaked its LCD for home health psych care. You can look up LCDs at www.cms.hhs.gov/DeterminationProcess/04_LCDs.asp.

• If you're accredited by the Joint Commission, you could see changes to the HR requirements. The JC (formerly JCAHO) wants your comments on proposed changes to human resources, infection control and information management standards in the HR chapter, the Oakbrook Terrace, IL-based accrediting body says.

You can access the changes and comment on them at www.jointcommission.org/Standards/SII/.

• Some home medical equipment suppliers are benefiting from the unsure, pre-competitive-bidding environment. The HME market saw 13 transactions in the second quarter of 2007, up from the previous quarter but down from the same quarter in 2006, notes The Braff Group. "Transaction volume today is being driven by smaller, local and regional firms capitalizing on an unsettled market to acquire modest-sized providers," Dexter Braff notes in a release.

The infusion market is seeing lots of private equity firm interest, which is likely to increase further after Walgreens' purchase of OptionCare Inc., which closed Sept. 12. The acquisition positions the Deerfield, IL-based chain "as the largest home infusion therapy provider in the country and expands its respiratory therapy and durable medical equipment services at some locations," Walgreens says in a release.

And the PPS changes seem like good news for the HHA mergers & acquisitions market. "Recently introduced PPS reforms appear manageable--and in some situations, favorable," Braff notes. Private equity firms continue to play a large part in the HHA market's activity, which is at 46 deals so far in 2007--up 12 percent thus far over 2006.

• The HHS Office of Inspector General has listed another DME fraud case. In New York, a DME supplier was sentenced to 15 months and $334,000 in restitution for his part in a scheme involving staged car accidents. Supposed accident victims were paid so they could be given DME billed to insurance, the OIG says on its Web site.