Home Health & Hospice Week

Congressional leaders set Oct. 17 deadline for Medicare legislation.

The final word on Medicare legislation might be just around the corner, and it could mean the world to your organization.

Republican leaders in the House and Senate have chosen Oct. 17 as the zero-hour for the compromise legislation regarding the prescription drug benefit and other Medicare-related issues, including home care provisions.

The issue also gained momentum when President Bush had a face-to-face meeting with the House and Senate conferees working on the compromise legislation. The President urged them to finish work on the bill, which requires ironing out the details between the House and Senate versions of the legislation (H.R. 1 and S. 1, respectively).

Although the legislation contains many provisions that could affect home care providers, there are three core proposals that would most impact home health agencies, says the National Association for Home Care & Hospice: a copayment for home health episodes, a cut to inflation updates, and a restoration of the 10 percent add-on for rural HHAs.

The copay and inflation cut would negatively affect agencies and their patients, while the add-on would be a big plus for rural HHAs struggling to stay afloat (see pf of Eli's HCW, Vol. XII, No. 32, p. 250).

Durable medical equipment suppliers' main issue is a proposal in the House bill to implement competitive bidding for DME. The Senate calls for a seven-year freeze on inflation updates instead, a better but still undesirable alternative.

Respiratory companies, infusion providers and pharmacies are worried about average wholesale price-related proposals, which would cut reimbursement to the bone for drugs such as the nebulizer medication albuterol sulfate.

The fate of the HHA priorities is looking up, judges William Dombi, vice president for law with NAHC's Center for Health Care Law. Although House reps appear to be standing strong on the issue of imposing home health copays, a majority of senators have offered a helping hand. Sens. Susan Collins (R-ME), Kit Bond (R-MO), Jack Reed (D-RI) and Russ Feingold (D-WI) submitted a "Dear Colleague" letter to Medicare conferees, urging them to adopt the home care provisions in the Senate bill - no copay, no inflation cuts and reinstitution of the rural add-on.

Fifty-seven senators signed on to the letter, which is "a potent number," Dombi notes. The letter "will help regarding home health issues," agrees Kathy Thompson with the Visiting Nurse Associations of America.

Home care providers and their patients also have gotten proactive about contacting their congressional representatives to urge no copay, Dombi says. Congressional offices report hearing much more on this issue than just a few weeks ago.

Some lawmakers also are rallying around DME suppliers' concerns. Rep. Dan Burton (R-IN) sent a Sept. 16 letter to the Medicare conferees, expressing concern about "the negative impact competitive bidding for DME products and services could have on many small businesses in my district," according to the American Association for Homecare. "I hope that the conferees will consider adopting an alternative approach to the competitive bidding system that is called for in the House version of the bill," the letter concludes.

Deadline in Doubt

Despite the flurry of activity surrounding the Medicare legislation, many observers doubt whether a final bill will even come to a vote, let alone meet the Oct. 17 deadline Republican leaders have set.

"There have been lots of dates set" so far for wrap-up of the package, Dombi points out. "They haven't met any of those."

The Medicare conferees themselves have been expressing their doubts of meeting the deadline. "October 17 is unrealistic," AAH's Ann Howard tells Eli.

The schedule lawmakers set for themselves "is already showing signs of slippage," AAH says.

In fact, numerous factors are likely to torpedo the chances of this bill altogether, Thompson predicts. Democrats' complaints that their concerns aren't being included in the compromise nego-tiationsdon't bode well for the measure's success.

A U.S. budget deficit and the President's request for $87 billion in additional military funding are more obstacles to the bill's passage.

Inability to agree on key provisions of a prescription drug benefit also could doom the package if lawmakers continue to resist splitting up drug and other Medicare provisions.

"I don't see how they are going to get much done at all this year," Howard says.

Maintaining the status quo for home care would most likely be a good thing for all but rural HHAs. With the exception of the rural add-on, the major home care-related proposals would take money out of providers' pockets.

Despite serious doubts about Medicare legislation's fate in Congress, the home care industry must continue to raise the profile of their concerns, Dombi cautions. "This could very well happen in short order," he tells Eli. "We won't know until the last minute."

"The fight is still on," Dombi stresses. "We think we're still in the game."