Home Health & Hospice Week

But HHAs are far from safe from spending cuts, experts warn.

Home health agencies may have won an important Medicare budget battle, but that doesn't mean they've won the war for fiscal year 2006 spending.

Senate action: HHAs are savoring the victory of Senate Finance Committee Chair Charles Grassley (R-IA) pulling a two-year market basket index freeze from the committee's FY 2006 budget reconciliation bill.

At press time, the full Senate was considering a budget reconciliation package that included the Finance Committee's legislation calling for $10 billion in Medicare and Medicaid cuts--but none for HHAs.

Grassley yanked the home care provision under pressure from fellow committee Republicans and constituents. "I am particularly pleased that this package addresses my concerns that home health care not be im-pacted," Sen. Olympia Snowe (R-ME) says in a release.

House action: And so far House budget legislation has left all Medicare providers, including HHAs, untouched. At the behest of the White House, leadership of both the House Ways and Means Committee and the House Energy and Commerce Committee included no Medicare cuts in their recently passed budget reconciliation packages. The bills do contain $9.5 billion and $11 billion in Medicaid cuts, respectively, however.

Bush administration officials are heading off Medicare provisions because they don't want to open up the Part D drug benefit to interference so close to its implementation date, Washington insiders say.

Timeline: The Senate is expected to vote on its overall budget reconciliation package by Nov. 4 and the House may follow as soon as a week later. Then Senators and Representatives will duke it out in conference over their bills' variances. The controversial differences in the Senate and House packages means a contentious reconciliation process that may drag on for weeks, experts warn.

Budget Storm Looms on the Horizon

Despite the positive signs, agencies shouldn't yet breathe a sigh of relief over the FY 2006 budget. "I don't feel at all safe," says Ann Howard with the American Association for Homecare. "Nobody should let their guard down," Howard tells Eli.

HHAs should "remain vigilant in opposing home health cuts of any kind in budget reconciliation," the National Association for Home Care & Hospice urges its members.

Watch out: Cuts to home care still threaten when the House and Senate go to work out the differences in their budget reconciliation packages. "That conference ... makes us very vulnerable," laments Kathy Thompson with the Visiting Nurse Associations of America. "We need to be very cautious."

Because the Senate legislation will most likely include Medicare cuts, the House lawmakers will counter with their own ideas for cuts and changes to the Medicare program--including possible reductions to the inflation update or copayments for home health services, experts predict.

House leadership, including Energy and Commerce Committee Chair Joe Barton (R-TX), have expressed a willingness to look at Medicare cuts, according to press reports.

House members are under intense pressure to increase spending for physicians due to the cut docs are set to face in 2006, Howard notes. If House negotiators support a physician spending increase or other Medicare change, they'll "go looking" for ways to pay for it--and home care "is a natural pay-for," Howard worries.

Reach out: HHAs should be contacting their senators and representatives now to raise their concerns about a possible rate freeze, copay or other cut, Thompson urges.