Home Health & Hospice Week

But don't get too attached to the 5 percent add-on currently in place.

It's tough to be a rural home health agency, and it may get even tougher if newly proposed legislation doesn't pass soon.

Sen. Susan Collins (R-ME) and six bipartisan cosponsors have introduced legislation that would extend rural HHAs' 5 percent payment add-on for another two years past its April 2005 expiration date.

"Home health care allows elderly individuals to stay at home and near their families, right where they belong," Collins said in introducing the bill, S. 2659.

Sen. Kit Bond (R-MO) offered a vivid example of why the add-on is needed. "When cuts in Medicare shut down a home health care agency in one rural county in northwest Missouri, 40 patients who had been treated for an average of $400,000 a year were forced to go to institutionalized care," Bond told the Senate when introducing the bill July 15. "Their cost for one year -- it was $400,000 -- became $1.4 million," Bond said.

Rep. Greg Walden (R-OR) will introduce companion legislation in the House any day, confirms his press secretary.

While the bill is quickly gaining popular support, chances of its passage in the 2004 session are slim to none, notes the Visiting Nurse Associations of America's Kathy Thompson. There simply is no likely vehicle for the legislation to move with, since a general Medicare legislation bill is off limits during this election year, says Jeff Kincheloe with the National Association for Home Care & Hospice.

The bill's sponsors realize it is unlikely to move this year, says a Senate aide close to the legislation. But they are planning "to get a head start" on an effort to pass the bill next year, the aide tells Eli.

If the bill's proponents can rally strong support before next session even begins, extension of the rural add-on is likely to be high on Congress'Medicare to-do list, Thompson predicts.

The goal "is to create a crucial mass of support leading into" the 2005 congressional session, agrees Kincheloe.

But no matter how strong support for the extension is, legislation is unlikely to be passed before the current add-on expires in April, Thompson says. That means rural agencies should brace for a reduction to their payment rates come April.

Watch for this: In addition to the rural add-on bill, Sen. Collins will introduce a bill regarding home health wage index some time after the August congressional recess, a Senate source says.

The bill is expected to give HHAs the same wage index reclassification rights that hospitals currently enjoy, Thompson says (see Eli's HCW, Vol. XIII, No. 20). And the legislation may propose that agencies "piggyback" on a hospital's wage index reclassification, she notes -- if a hospital wins a reclassification, it automatically would apply to HHAs in the hospital's area too.

The bill also might seek to limit how much a wage index, which helps set HHA payment rates, can drop in one year, Kincheloe adds.