Home Health & Hospice Week

Congress one step closer to finalizing Medicare budget for 2006.

As the House and Senate prepare to enter negotiations over their budget packages, home care providers wait anxiously to see if lawmakers will take their final opportunity to make big cuts to Medicare home care spending in 2006.

The House passed its budget reconciliation package by only two votes Nov. 18, delivering legislation that contained no Medicare cuts but about $12 billion in Medicaid cuts. The budget package passed Nov. 3 by the Senate contains no cuts to home care spending either (see Eli's HCW, Vol. XIV, No. 40).

Despite the two positive budget bills, home health agencies still may be in for trouble when the Senate and House head to conference to work out the differences in their budget reconciliation packages. "I don't think we're out of the woods yet," the Visiting Nurse Associations of America's Kathy Thompson tells Eli.

Congress is under intense pressure to correct the physician payment formula for Medicare to the tune of about $20 billion, the American Association for Homecare warns. Centers for Medicare & Medicaid Services Administrator Mark McClellan says CMS supports a physician payment fix, which will head off a 4 percent reduction in physician payments next year.

"This leaves home care at great risk of cuts to pay for the physician [sustainable growth rate] fix," AAH warns.

Providers should stress to lawmakers that home care is cost effective, clinically effective, and patient-preferred, AAH urges. "Home care is not the problem, it's the solution."

The conference committee is expected to be announced and start negotiating by mid-December when Congress reconvenes, observers say. • A survey that's making its way to home oxygen providers may be used to support future cuts to their reimbursement rates. So warns AAHomecare about the survey being conducted by the HHS Office of Inspector General.

The survey may not fully capture all of the services that accompany home oxygen therapy--especially those services that do not routinely require documentation, AAH says. The trade group is asking providers who do receive the survey to return it promptly, as the OIG may not grant extensions. • The influential Medicare Payment Advisory Commission may give therapy visits a hard look over the next year. As part of its study of the prospective payment system's payment adequacy, Med-PAC is looking at the OIG's three audit reports that denied a large percentage of therapy visits.

The audits "suggest that the same quality of care could have been achieved with the use of fewer resources," MedPAC staffer Sharon Cheng said in the commission's November meeting. "The Commission may wish to take into account this indication about payments and costs."

Medicare spending on home health has risen 40 percent since PPS began in 2000, while [...]