Home Health & Hospice Week

The outcome of Medicare legislation - and particularly its home care provisions - could depend on tough negotiations occurring in the House at press time.

In that chamber of the U.S. Congress, the House Rules Committee is hammering out differences between Medicare bills approved by the Ways and Means Committee and the Energy and Commerce Committee, both of which have jurisdiction over Medicare.

The main issue: copayments for home health agency services. Ways & Means' bill calls for Medicare beneficiaries to pay a copay equal to 1.5 percent of the episode amount, while Energy & Commerce's bill has no copay provision.

Industry lobbyists say they've been receiving mixed messages on whether the final, unified bill the entire House will vote on will include the copay. A vote is expected by June 27.

Inflation Reductions, Competitive Bidding A Sure Thing In the House

Provisions in the bill that are more certain of inclusion are a reduction to the inflation update for HHAs and competitive bidding for durable medical equipment. Both Ways & Means and Energy & Commerce include those measures in their respective bills. The inflation reduction is a 0.4 percent reduction to the market basket.

The House bills include a number of positive provisions as well, though, points out Kathy Thompson with the Visiting Nurse Associations of America.

They call for a 5 percent add-on for rural agencies, a suspension of OASIS requirements for non-Medicare, non-Medicaid patients and some demonstration projects for homebound patients in adult day care and for chronic care.

Once the House approves a bill, the House and Senate will form a conference committee to work out the differences between their two bills.

The Senate bill is expected to be friendlier to HHAs but is a mixed bag for DME suppliers. The bill, which at press time had been approved by the Senate Finance Committee and was undergoing debate on the Senate floor, does not include an HHA copay or a reduction to HHA inflation updates as the House bills do.

The Senate bill does call for a seven-year freeze to inflation updates for DME and a reduction in drug pricing, from 95 percent to 85 percent of average wholesale price. On the other hand, it doesn't propose DME competitive bidding as the House bills do.

Both the final House and Senate bills are expected to include an add-on for rural HHAs, most likely at 5 percent for two years.

It appears both houses of Congress will make a final vote on their Medicare legislation before the July 4 recess, and President Bush has called for a compromise bill from Congress by the end of July. But working out the differences between the House and Senate bills, especially the prescription drug benefit provisions, could take longer, experts predict, putting off the final word on home care changes until late in the summer at the earliest.