Home Health & Hospice Week

The only thing standing between you and deep Medicare cuts may be your congressional representatives, and even that barrier may disappear by 2014.

That's the year the Independent Payment Advisory Board would replace the Medicare Payment Advisory Commission. The presidentially appointed 15-member IPAB, called "Super MedPAC" by some, will recommend cuts in Medicare payment rates.

The difference: If Congress doesn't vote either for or against IPAB's recommended cuts, the cuts would take effect.

In recent years, MedPAC has repeatedly recommended steeper pay cuts than Congress has imposed on home care providers. In an IPAB era, those steeper cuts could hit providers instead.

Unless: Rep. Phil Roe (R-Tenn.) and 23 other Republicans have introduced legislation to repeal the IPAB mandate. In introducing the

Medicare Decisions Accountability Act (H.R. 452), Roe, who is a physician, said, "This board's sole purpose is to control Medicare costs -- giving this board the authority to approve and deny funding for care... My concern is that this board will harm patient care."

But getting rid of IPAB may get held up by political considerations. Republicans are launching their assault on the Affordable Care Act's entire health reform program by picking the most unpopular ACA provisions first, including IPAB. That may mean that the legislation will fail to garner necessary bipartisan support, even though many Democratic lawmakers are opposed to the board.

Another repeal sought: Part of the Republicans offensive against the ACA would also help many home care providers. Rep. Dan Lungren (RCalif.) has reintroduced the Small Business Paperwork Mandate Elimination Act of 2011 (H.R. 4, formerly H.R. 144), which would repeal the so-called 1099 provision of the health care reform law.

Under the provision, beginning next year, all businesses -- including nonprofits and government entities -- will have to file a 1099 form with the Internal Revenue Service reporting any purchases of goods or services of $600 or more in a tax year. Under current law, the 1099 requirement applies only when the vendor is unincorporated.