Home Health & Hospice Week

Budget negotiations may be entering the eleventh hour.

Senate and House leaders are negotiating over Medicare and Medicaid cuts in their budget reconciliation packages, leaving home care a prime target for the chopping block.

Senate Finance Committee Chair Charles Grassley (R-IA), House Ways and Means Committee Chair Bill Thomas (R-CA) and House Energy and Commerce Committee Chair Joe Barton (R-TX) are hammering out the differences in the House and Senate reconciliation packages' cuts to the programs. The leaders are trying to find ways to fund changes to the bills, including a possible increase to physician payments,according to press reports.

That means a draft recommendation from the Medicare Payment Advisory Commission couldn't have come at a worse time. In its Dec. 8 meeting, MedPAC proposed recommending a freeze for home health agencies' 2007 Medicare rates, just as it recommended a freeze for 2006 rates.

HHAs currently have a profit margin of about 16 percent and MedPAC staff estimate the margin will be 16.9 percent in 2006. Beneficiaries appear to have few access problems and Medicare has seen 500 new HHA entrants in the past 12 months, MedPAC staffer Sharon Cheng reported.

"Agencies should be able to tolerate price increases without an increase to base payments," Cheng said. The finalized recommendation will go into MedPAC's March report to Congress.

But Congressional leaders are hearing a different message from fellow lawmakers.

Fourteen senators and seven key House members signed onto letters urging budget conferees to "reject any consideration of reductions to the Medicare home health benefit as part of the final conference agreement," according to the National Association for Home Care & Hospice.

At press time, it was unclear if Congress would wrap up budget negotiations before Christmas or continue working on the matter into 2006. Even if the conferees agree on a compromise bill, there's no guarantee it will pass the full House and Senate, NAHC notes. • VistaCare Inc. will continue serving patients in Indianapolis and Terre Haute, IN the Scotts-dale, AZ-based hospice chain says. The for-profit company's two offices in those cities were decertified in October (see Eli's HCW, Vol. XIV, No. 38).

VistaCare will operate in Indianapolis by moving its Bloomington provider number to Indy, thereby allowing both locations to operate under the number. The Centers for Medicare & Medicaid Services and the Indiana State Department of Health have approved the solution, the company says.

In Terre Haute, VistaCare has continued serving more than 100 patients without reimbursement while it requests a new survey and provider number. "The issues leading to the decertification in Indianapolis were not present in Terre Haute," the company says in a release. "It is our hope ... we will be able to work with ISDH and CMS to receive a prompt and successful [...]