Home Health & Hospice Week

Home care providers need to brace for reimbursement woes if Congress finally passes its health care reform package.

After House and Senate passage of their respective reform bills, Congress' ability to send one approved reform bill to President Obama is looking more likely.

Watch out: To get the legislation to the president's desk by his State of the Union address next month, Democratic lawmakers are discussing unconventional ways of securing passage of the bill.

Those routes will most likely bypass the usual conference committee that would work out differences between the House and Senate versions of the bill.

Why it matters: While both bills contain tens of billions of dollars in cuts to home health agency and hospice Medicare rates, the Senate bill is friendlier to the industry, observers say. It includes no reimbursement changes for 2010 and 1 percent reductions to the inflation update in 2011-2013, the National Association for Home Care & Hospice notes.

One of the routes to approval that lawmakers are considering is having the House pass a bill with the changes made in the Senate version. That's because the Senate had a much narrower margin of victory for its legislation. Then the Senate would approve the House-passed version and it could go to the president.

That could be good for home care, since the Senate's cuts are slightly less drastic than those in the House bill. But either way will spell payment reductions for providers.

Another problem: The Senate bill contains a separate provision that could be bad news for home care providers. Besides out-and-out payment cuts, the Senate bill calls for an advisory body similar to the Medicare Payment Advisory Commission to set payment levels for Medicare providers.

The so-called Independent Payment Advisory Board (IPAB) would be presidentially appointed.

The bill "would give IPAB too much power, forcing Congress to yield its power to the Executive Branch," NAHC protests. "Further, IPAB would not have broad-based experience given that it would be comprised of just 15 members appointed by the president. Home care and hospice expertise is less likely to be a part of such a small group."

The IPAB proposal has another problem, the trade group maintains. "Unpredictability would reign from year to year as IPAB could change rules with little input from Congress or the public," NAHC worries.

Meanwhile, because the health reform package doesn't currently address durable medical equipment suppliers' main concerns this year -- competitive bidding and oxygen caps -- suppliers are rallying support for another bill, H.R. 3790, the American Association for Homecare reports. That legislation would eliminate DME bidding.

• Growth in spending for home care is slowing down, but probably not enough to let home health agencies off the budget-cutting hook this year. "Spending growth for freestanding home health care services decelerated from 11.8 percent in 2007 to 9.0 percent in 2008," the Centers for Medicare & Medicaid Services says in a new report from its Office of the Actuary. "Expenditures reached $64.7 billion in 2008," the report notes.

The spending slowdown was due in large part to Medicare and Medicaid rates, since the programs account for nearly 80 percent of home care spending, CMS says in an article in the journal Health Affairs.

Spending on DME, including items like hearing aids and eyeglasses, increased from 3.3 percent in 2007 to 4.1 percent in 2008, CMS says.

Expenditures reached $26.6 billion in 2008. Total U.S. health spending grew 4.4 percent in 2008, while Medicare spending grew 8.6 percent, CMS adds.

• New appeals provisions taking effect this month could make your appeals cases easier to handle. CMS issued a final rule on Dec. 9, 2009 that took effect Jan. 1, notes law firm K&L Gates.

The rule's provisions focus largely on timeframes for appeals, K&L Gates notes. For instance, if the Administrative Law Judge (ALJ) or Medicare Appeals Council (MAC) doesn't issue a decision on your case within 90 days, you can escalate the case to the next level of appeal.

To find out more specifics about the new appeal process, check out regional home health intermediary Cahaba GBA's updated appeals Web site at www.cahabagba.com/rhhi/appeals/index.htm.

"You can find links to information about all the different levels of Medicare appeal," Cahaba tells providers in an e-mail message.

Plus: "For reconsiderations, the first level of appeal, you will find specific information about how to submit a reconsideration, how to check the status of your appeal request, as well as the time frame in which an appeal needs to be submitted, and the amount of time we are given to make a determination on the appeal request," Cahaba says.

• If you furnish outpatient Part B therapy, don't count on therapy cap exceptions to cover your patients' services this year. The therapy cap exceptions process expired on Dec. 31, CMS notes in a new MLN Matters article at www.cms.hhs.gov/MLNMattersArticles/downloads/SE0931.pdf. But don't lose all hope. "We believe some or all of these provisions may be extended as part of [currently pending] legislation,"

CMS says in the article. "We encourage you to monitor activity on the Hill and stay apprised of the status of potential legislation." Both the House and Senate bills contain provisions to extend the therapy cap exception process, NAHC notes.

Remember: The cap applies only to Part B outpatient therapy, not therapy furnished under a home health plan of care.

• The HHS Office of Inspector General wants your input on potential new safe harbors in the federal anti-kickback statute and topics for Special Fraud Alerts, the federal watchdog agency says in the Dec. 29, 2009 Federal Register.

"A detailed explanation of justifications for, or empirical data supporting, a suggestion for a safe harbor or Special Fraud Alert would be helpful and should ... be included," the OIG says in the notice. Comments are due by March 1.

• Pharmacies furnishing DME might get a little breathing room on their accreditation requirements. CMS is continuing to process accreditation determinations for pharmacies, it says in a message to providers. "The revocation process for those who do not meet the accreditation requirement will be prioritized based on any potential beneficiary access issues as well as the Agency's workload," CMS admits.

In the meantime, pharmacies should continue with any accreditation processes, CMS instructs. A pharmacy's accrediting body will notify the National Supplier Clearinghouse of new accreditation determinations.

• RHHI Palmetto GBA has revised its local coverage determinations (LCDs) for occupational and physical therapy for home health. In revisions that took effect Jan. 1, Palmetto made changes to its documentation requirements, utilization guidelines, and codes in the determinations. The changes mainly address comprehensive outpatient rehab facility (CORF) services.

• The new year brings new locations for home care chain LHC Group Inc. The Lafayette, La.-based company has bought the assets of Access Hospice Care in Branson, Mo., which has $1 million in annual revenues. LHC bought Access' HHA business in 2008, the company notes in a release.

LHC also has entered into a joint venture with Preston Memorial Hospital in Kingwood, W. Va. The agency with $640,000 in annual revenues serves five counties in the certificate of need (CON) state, LHC notes.

• Amedisys Inc.'s latest acquisition marks its entry into a new state. The national HHA chain has purchased the home health operations of Hackensack University Medical Center in New Jersey, the Baton Rouge, La.-based company says in a release. The agency, which serves Bergen and Hudson counties in the CON state, has annual revenues of $19 million, Amedisys says.