Home Health & Hospice Week

House reps insist on home health copay. 

Congressional leaders have returned to their Medicare and prescription drug bill negotiations full force, but there may not be much to show for it.

Senate Majority Leader Bill Frist (R-TN) has projected a late-September deadline for the Medicare bill talks, but congressional insiders say it may be November or even December before negotiations wrap up and a vote is held on the legislation.

"We may be inching toward nothing happening," observes William Dombi, vice president for law with the National Association for Home Care & Hospice's Center for Health Care Law. It's too early to tell how home care-related provisions will fare in the legislation, if the legislation even makes it to a vote, Dombi says.

One obstacle to the legislation's progress has been lifted. Senate Finance Committee Chair Charles Grassley (R-IA) and House Ways and Means Chair Bill Thomas (R-CA), who are heading up the negotiations, appear to have buried the hatchet on rural disagreements. Grassley earlier pulled his staff from negotiations, accusing Thomas of stalling on rural provider issues.

The further out the deadline for Medicare legislation is extended, the better it could be for home care providers, Dombi notes. The delay gives providers ample time to submit their concerns with the legislation to their representatives in Congress.

And the bill's plodding progress is an indicator that it might not succeed at all this session. No legislation would be better than legislation that carries the negative home care provisions, including a copayment and cuts to inflation updates, Dombi judges. The bill appears even worse for durable medical equipment suppliers, with either a multi-year inflation update freeze or competitive bidding in store.

On the other hand, there are some provisions home health agencies really want from the legislation, Dombi points out. Topping the list are restoration of the 10 percent rural add-on and regulatory relief including elimination of OASIS for private-pay patients.

While no bill is better than a bad bill, a "fixed" bill is best of all, Dombi concludes.

And that is still a distinct possibility, observers note. Sens. Susan Collins (R-ME), Kit Bond (R-MO), Jack Reed (D-RI) and Russ Feingold (D-WI) are circulating a "Dear Colleague" letter, urging other senators to sign onto the missive that asks Senate conferees to stick by the home care provisions in the Senate-passed Medicare legislation. Those include no copay, no cut to cost-of-living updates and restoration of the rural add-on.

Industry leaders are exhorting home care providers to keep up their communications with legislators for the duration of the talks, urging the lawmakers to adopt favorable home care provisions. Congressional offices report hearing from a large number of constituents about the new proposed lab copays, but hearing little on home health copays, Dombi says.

Home care lobbyists got a chance to contact their representatives at the Sept. 10 "March on Washington" sponsored by NAHC and the American Association for Homecare, Dombi added.