Home Health & Hospice Week

Other more minor but still positive provisions include allowing nurse practitioners to be counted as "attending physicians" for hospice purposes. They would therefore be able to establish and review care plans.

Physicians still must certify patients as terminally ill with a six-month prognosis to qualify for the hospice benefit, however, notes the Visiting Nurse Associations of America.

While most other drugs' Medicare reimbursement rates will drop to 85 percent of average wholesale price under the bill, the program will continue to pay for flu vaccinations at 95 percent of AWP until a new pricing system takes over.

The Bad News:

Pennsylvania HHAs told the Wilkes-Barre Times Leader that the cuts in the legislation, estimated at $6.5 billion over 10 years, could force them to restrict services. "They're killing home health," said Debra Popovich, director of Personal Care Home Health Services in Kingston. "It's going to be very difficult."

Congress approved a three-year demonstration project that will take place in 10 states, requiring home health agencies, hospices, personal care providers, skilled nursing facilities and others to conduct beefed-up background checks on direct care employees. However, the legislation doesn't require HHAs to conduct or pay for the pricey FBI 10-fingerprint check; instead, it "permits" providers to conduct the checks, the VNAA notes.

It does require providers to reference currently available registries for disqualifying information, however, points out the American Association for Homecare in its legislation summary. The background check wouldn't apply to workers hired by the patients through self-directed care programs.

The impact of some of the bill's provisions will take years to determine, as demonstration projects play out, studies are conducted and regulations based on the legislation are written. One demonstration that holds promise is an expansion of the homebound criteria for home care patients.

A two-year demonstration project will begin next year in three states, and could include up to 15,000 beneficiaries with severe and chronic illnesses and disabilities. Patients who meet a list of requirements would be exempt from the homebound requirement to see if utilization and cost of the home care benefit would increase under such changes.

One of the studies most critical to HHAs may be the Medical Payment Advisory Commis-sion's inquiry into agencies' payment margins under the prospective payment system. MedPAC's assertion in January that agencies' Medicare payments on average were 22 percent higher than their costs was damaging to the industry's credibility when it lobbied for home care-favorable provisions this legislative session.

Regulatory reforms, including not penalizing providers for following faulty intermediary advice, could help HHAs. But moving the administrative law judges out of the Social Security Administration and into the Department of Health and Human Services could close down that historically favorable avenue of appeals. Language in the bill does require ALJs to remain independent of CMS, however.

President Bush is expected to sign the bill into law Dec. 8, with much publicity focused on the new prescription drug benefit. v

Editor's Note: A summary of the bill's home care, hospice, infusion and durable medical equipment provisions is available from the VNAA at www.vnaa.org.