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 response to our request."

VistaCare reported a loss of $5.1 million on $53.9 million in revenues for the quarter ended Sept. 30, compared to a $6.2 million loss on $48.7 million in revenues for the same period in 2004. Medicare cap exposure contributed to the loss, the company says.

• Expect shortages of influenza vaccine to be alleviated soon. CMS is releasing more vaccine in a tiered fashion, and all doses should be out by the end of December. Keep vaccinating through the end of March, CMS told the Dec. 6 physician Open Door Forum.

• Claims corrections for providers using Direct Data Entry (DDE) are on hold. "Providers are not currently able to correct claims via DDE," regional home health intermediary Palmetto GBA says on its Web site. Medicare contractors have reported this issue to the Fiscal Intermediary Shared System (FISS) maintainer.

"Providers may opt to resubmit a new claim with the appropriate corrections until the DDE claims correction issue is resolved," Palmetto offers. The RHHI also furnished on its Web site a workaround for providers experiencing difficulty sorting their claims prior to accessing their RTP claims for correction.

• The list of who can bill Medicare directly for durable medical equipment has lengthened. The Medicare Modernization Act permits Indian Health Services facilities to bill directly for itemized DME, prosthetics, orthotics and supplies as of Jan. 1, 2005. CMS this month issued a change request offering instructions on how IHS facilities can enroll as suppliers, with instructions effective April 3, 2006.

For details, see the recent Medlearn Matters article online at www.cms.hhs.gov/medlearn/matters/mmarticles/2005/MM3845.pdf.

• A Maryland task force is proposing to scrap the state's certificate of need (CON) requirements for home health agencies, reports the Baltimore Business Journal. The state could benefit by eliminating the time-consuming regulatory process, says the panel appointed by the Maryland Health Care Commission to streamline Maryland's health care regulations.

Opponents including the Johns Hopkins Home Care Group and Maryland National Capital Homecare Association say access to quality care would be jeopardized and scarce nursing staff would be poached by newcomers with eyes only for profits, the paper says. The commission will consider implementing the proposal, which will require a change to state law, at its December meeting.

• Tennessee's Medicaid program is dropping thousands of residents who thought they would remain covered by TennCare, reports the Chattanooga Times Free Press. The program already has disenrolled 191,000 people this year.

Beneficiaries who qualify for Medicare Part D coverage will lose their TennCare coverage for prescription drugs, along with home care and other services, the paper notes. "Hardly any other state Medicaid program ... pays a nurse to deliver in-home care," TennCare spokeswoman Marilyn Elam said.

• Heritage Home Healthcare in Santa Fe, NM has filed suit against the city's local minimum wage law, reports the Albuquerque Journal. Heritage says it is losing money by paying workers the mandated hourly wage of $8.50.

The lawsuit seeks to have the living wage law declared unconstitutional, the newspaper says. The suit comes as the City Council considers delaying an increase in the wage rate from $8.50 to $9.50 an hour that otherwise will go into effect in January.