Home Health & Hospice Week

Danger lurks in Senate-House conference, lobbyists warn.

Home care providers are holding their breath to see what, if any, home care cuts Congress doles out in its 2006 budget reconciliation package.

House leaders had expected to secure passage of the House's version of the package by Nov. 10, but they had to push off the vote when they failed to get the votes needed from Republicans for approval. The Senate approved its reconciliation legislation Nov. 3 (see Eli's HCW, Vol. XIV, No. 40).

"We're in pretty good shape" so far, says Ann Howard with the American Association for Homecare. The Senate bill already contains no cuts to home health agency spending. And if the House budget reconciliation legislation passes, it looks to do so with no Medicare cuts at all, Howard notes. Both the approved Senate bill and pending House bill include billions in Medicaid cuts, however.

"It's looking better and better for us," agrees Kathy Thompson with the Visiting Nurse Associations of America. To secure support for the House bill, Republican leadership had to make some concessions on entitlement spending to moderates in their party, Thompson notes. That is likely to lead to a House bill with lower overall savings.

If the House package, which originally called for about $54 billion in spending cuts, can get closer to the Senate bill, which contains about $35 billion in savings, lawmakers working out the compromise between the two bills won't have to go looking for more offsets, Thompson notes.

The bills "still aren't equal, but it takes some of the pressure off to find pay-fors," Thompson tells Eli. That means home care may become less of a target for legislators looking for budget-cutting sources.

Stay Vigilant

But HHAs still must be wary, Howard warns. A big battle may be brewing for the House-Senate conference on the reconciliation package.
 
Despite popular support for home care in Congress, the representatives working out the compromise bill could stick in a home care cut provision at the last minute and rank-and-file lawmakers could be compelled to vote for it, Howard predicts.

That's an especially likely scenario if the compromise package increases spending to solve other Medicare problems like the looming physician pay cut or the moratorium on the outpatient therapy cap. "Everybody's vulnerable," Howard notes.

"Key members of Congress have expressed continuing concern about the physician payment cuts," notes the National Association for Home Care & Hospice. "Pending legislation crafted by the Senate Finance Committee would provide a 1 percent increase for Medicare physician services for 2006."

Don't Count on a Budget Christmas Present

Timeline: If the House passes its budget bill before Thanksgiving, the House-Senate conference will commence soon after Congress returns from vacation in early December, experts predict. If all goes smoothly, conferees could hammer out and Congress could approve a budget reconciliation package by Christmas.

If negotiations are rough, Congress could pass a continuing resolution keeping the government operating and continue to work on the package into January and February, Thompson foresees.

"If the House and Senate cannot easily arrive at a compromise budget package, discussions of home care cuts in the form of a payment freeze or even a beneficiary copayment could resurface," NAHC warns.

Or lawmakers could give up hope for a reconciliation package, just pass the appropriations bills necessary for 2006, and go back to the drawing board next session for 2007, Howard offers. This might be the best option for home care, since it would likely mean no home care cuts for 2006.

What to do: Home care providers should stress to their legislators how cost effective home care is, by keeping Medicare patients out of institutions, Howard recommends.

NAHC urges HHAs to thank their legislators for excluding home care cuts from current bills. And agencies should encourage their reps to keep the cuts out of any final budget bills.