Home Health & Hospice Week

HHAs still will have tough fight this year.

You'd think if both the House and Senate list no Medicare cuts in their respective budget resolutions for fiscal year 2007, that home care providers would be safe--but think again.

After the Senate excluded Medicare and Medicaid cuts from its budget resolution in March (see Eli's HCW, Vol. XV, No. 12), the House followed suit in its budget resolution that passed narrowly May 18.

But the House resolution does call for the Ways and Means Committee to cut $4 billion in spending over five years from programs under its jurisdiction, which include Medicare and Medicaid. Repub-lican House leaders say those cuts won't affect Medi-care or Medicaid, but nothing in writing prevents that.

Cut dodged: In passing the resolutions, Congress rejected the proposal from President Bush earlier this year to strip nearly $4 billion over five years from home health agencies' budgets via a 2007 rate freeze and 2008 and 2009 inflation update reduction (see Eli's HCW, Vol. XV, No. 6).

Leaving out the cuts "is really important," says Ann Howard with the American Association for Homecare. Lawmakers aren't "looking at Medicare as a piggybank" to fund other things, Howard says.

It's best not to start out in the budget process with strikes against you, agrees Kathy Thompson with the Visiting Nurse Associations of America.

A threat still looms that the House and Senate could include Medicare cuts in a reconciled version of the non-binding budget blueprint for 2007. But observers are skeptical they can come to any agreement on a resolution in this contentious election year.

Fighting a Ghost Cut

However, a very real threat is the physician payment fix Congress is likely to approve either at the end of the congressional session or in a lame duck session after elections, notes Yvonne Santa Anna with the National Association for Home Care & Hospice. Like last year, Medicare physician payments will be cut if Congress doesn't approve an increase to them. And like last year, lawmakers may turn to home care to fund the fix.

"We're still not out of the woods," Thompson warns. Last year neither the House nor Senate budget resolution or budget bills contained home care cuts. But when congressional leaders went behind closed doors to hammer out the budget agreement between the House and Senate, the 2006 HHA payment freeze ended up in the final bill, the Deficit Reduction Act.

"We know we are at risk whether a budget resolution passes or not," Howard tells Eli. Home care providers will have to hammer away at their congressional representatives all year to protect themselves against another last-minute HHA cut sneaking into the budget.

Home care payments are at risk "every day that Congress is in town," Howard cautions.

Take action: HHAs should urge their House and Senate representatives to protect the industry, which has seen drastic cuts over recent years, from further reductions, Santa Anna advises. And they should urge their Senators to sign onto the Dear Colleague letter circulated by Sen. Susan Collins (R-ME) urging Senate Finance Committee leaders to shun home care cuts.

"We'll have to be vigilant all year," Thompson predicts. Fighting a cut that hasn't even been proposed in Congress makes it that much harder, she adds. "It's like fighting a ghost that could come back to haunt you."