Home Health & Hospice Week

Doc fix bill could cost HHAs $130 billion, trade group warns.

Serious lobbying by health care providers is taking place in advance of the Senate’s return April 13, and HHAs will find out shortly if it’s done them any good.

Recap: Congress made it to the halfway point of passing a so-called “doc fix” bill before taking a recess before Easter. On March 26, the House of Representatives passed by a large margin the bill eliminating the Sustainable Growth Rate (SGR) payment formula for physicians. It was set to move into the Senate for confirmation, after which President Obama would have to sign it before it became law. But Senators did not bring the vote to the floor be-fore leaving for a two-week recess on March 27.

The Centers for Medicare & Medicaid Services is currently holding physicians’ claims, waiting to see whether Congress will pass the legislation that will avert the 21 percent reimbursement cut for docs that took effect on April 1. Instead of temporarily halting the pay cut through the end of the year like Congress has done 17 times in the past, legislators are trying to permanently fix the Medi-care payment formula this year instead of continuing to offer temporary fixes to the SGR issue.

To help pay for the estimated $200 billion fix, home health agencies and hospices are among the post-acute providers that would take a pay reduction in 2018, reducing inflation updates to only 1 percent.

Plus: The bill also would require HHAs to provide the Secretary with a surety bond — “(A) in a form specified by the Secretary and in an amount that is not less than the minimum of $50,000; and (B) that the Secretary determines is commensurate with the volume of payments to the home health agency,” according to the bill text.

In other words: The very least the bond amount would total would be $50,000, notes Indianapolis law firm Hall Render in analysis of the legislation. The bond amount would increase with revenues.

Take action: The National Association for Home Care & Hospice urges agencies to ask their members of Congress to remove the SGR bill’s surety bond requirement on HHAs and add language repealing or revising the face-to-face physician documentation rule.

“While it may be unlikely that Congress will either open the bill for amendments or accept more than a small number of amendments agreed upon in advance, we want to make another effort to stop the surety bond and obtain F2F relief in the SGR legislation,” NAHC says in its member newsletter. “At a minimum, the effort will help set the stage for further advocacy as Congressional leaders have indicated they expect more Medicare legislation later this year.”

Is A Bond Requirement Inevitable?

Medicare has had the authority to impose a surety bond on HHAs for years, but has chosen not to -- despite urging from the Government Ac-countability Office, the HHS Office of Inspector General and others (see Eli’s HCW, Vol. XXIII, No. 19 and Vol. XXII, No. 44). The Obama administration has repeatedly included the measure in its budget proposals. 

The bond requirement would bring only $10 million in Medicare savings over 10 years, while NAHC estimates the cost of the bonds to be $130 million over that same period of time, the trade group protests. “The small savings is indicative of the fact that virtually all Medicare overpayments are fully repaid by home health agencies. While achieving minimal savings, the nonsensical surety bond requirement could drastically harm agencies and limit access to care.”

Stay tuned: The Senate is expected to take up the doc fix bill as soon as it returns from recess April 13. Senate leadership has expressed its intention to pass its version of the legislation. 

Note: See the text of the legislation the House passed at http://thomas.loc.gov/home/gpoxmlc114/h2_eh.xml#toc-H3ACAEE0E78884A45AD966C6C1888B61D.