Home Health & Hospice Week

Background Check Proposal Catches HHAs By Surprise

The Medicare bills passed by the House and Senate right before Congress' July 4 recess held a few surprises for home care providers, but not many of them were good ones.

As expected, the House bill contained the most negative provisions for home health agencies and durable medical equipment suppliers. The bill, which passed on a razor-thin 216-215 margin, calls for competitive bidding for DME, a 0.4 percent reduction to the inflation update for HHAs, and a 1.5 percent per-episode copay for home care.

The Senate bill, which passed 76-21, contains none of those provisions, although it does call for a seven-year freeze to inflation updates for DME. Still, the update freeze is better than the competitive bidding provision, the American Association for Homecare says, and suppliers should tell their legislators to opt for it.

And the Senate bill proposes a background check requirement for HHA and nursing home caregivers. The provision would allow states to charge agencies $50 per background check. While the checks would create a handy centralized database for the nation, it would impose additional burdens on agencies.

Amendments in the House to strike or delay the copay and bidding failed, AAH notes.

Not all the surprises were bad ones, though. Both the House and Senate bills ended up including proposals for suspension of OASIS collection for non-Medicare, non-Medicaid patients and demonstration projects clarifying the definition of "homebound," points out Kathy Thompson with the Visiting Nurse Associations of America.

And Sen. Susan Collins (R-ME) successfully proposed an amendment increasing the HHA rural add-on to 10 percent over three years, AAH says.

Tough Conference Lies Ahead 

Now that the bills are passed, the Senate and House must hammer out their differences in a conference committee made up of both senators and representatives. And the main issues on the agenda are not likely to be home care and DME issues. Rather, the proposal to add a prescription drug benefit to Medicare will claim the spotlight.

President Bush has called for the conference committee to produce a bill before Congress' August recess, but onlookers doubt the committee will make that deadline. The issues are too complex and the bill too massive to facilitate quick negotiations, observers say.

And the longer the package goes unpassed, the more its flaws will be pointed out, Thompson notes. "Who's to say what the success of the package will be" after the August recess, she says.

For home care, a Medicare bill that flounders might not be a bad thing, points out William Dombi with the National Association for Home Care & Hospice. The copay, the inflation reduction and competitive bidding could just go away for this year if the bill fails.

But also going away would be the OASIS suspension, the rural-add on for HHAs, and other favorable provisions for HHAs and hospices.

Legislators have been non-committal on whether they will strongly back provisions favorable to home care providers, lobbyists say. The industry is counting on Senate participants to push their home care agenda in the negotiations.

At press time the Senate had named its conferees, but the House had yet to do so.