Congressional Correspondence

Dear Senator Feingold:

On behalf of the National Association for Home Care (NAHC), the nation's largest home health organization representing home health and hospice providers, caregivers, and the patients they serve, I am writing to extend my appreciation and support for the "Home Health Nurse and Patient Act of 2001."

Your legislation would help to reduce the regulatory burdens associated with the Outcomes Assessment and Information Set (OASIS), the Advanced Beneficiary Notice (ABN) and demand billing process, and claims review and auditing. Streamlining and improving these regulatory requirements would help reduce costly and unnecessary paperwork burdens on home care agencies and staffs and free up more time for patient care.

As you point out, existing federal regulations and associated paperwork requirements are excessively straining home health agencies and their clinical staffs. Agencies are not adequately reimbursed for the costs of these regulatory burdens and patients complain about the collection of data that is unnecessary, duplicative, and invasive of their privacy. Nurses and home health aides are leaving the home health care profession, often frustrated by the amount of time they must spend on paperwork, which detracts from patient care.

We strongly support the provision in your bill that would eliminate the requirement to collect Outcomes Assessment and Information Set (OASIS) data from non-Medicare/Medicaid patients and those receiving personal care only. While this change would be a significant improvement over the current standard, NAHC believes that OASIS should be restricted to Medicare patients at this time. We commend you for directing a task force to review whether collection of OASIS data, which was designed for the unique Medicare population, is appropriate for Medicaid patients. We also think the frequency of OASIS assessments and the number of questions asked are excessive and are pleased that the task force would seek to address these issues.

The bill directs the Secretary of HHS to review and improve the way in which the Advanced Beneficiary Notice (ABN) and demand billing process is applied to individuals who are both Medicare and Medicaid beneficiaries. This is a significant issue that certainly bears close scrutiny and creative thinking to come up with solutions.

A Claims Review and Audit Task Force established by this bill would consider some important and long overdue measures, including imposing reasonable time limits on regional home health intermediaries for review of claims; factoring successful appeal determinations into decisions on whether to continue a focused medical review of a home health agency; eliminating technical denials of claims by allowing resubmission as a clean claim; allowing physician assistants and nurse practitioners to certify and make changes to home health care plans of care; and the development of a sampling regulation through the rulemaking process that is statistically supportable and only used as a last resort for the recoupment of overpayments.

In conclusion, I would like to lay out for you the reasons we believe that OASIS should be restricted to Medicare patients only. Perhaps this information will be a good starting point for the OASIS task force that is created under your bill.

• There are serious questions about the value of OASIS data for non-Medicare patients, given the different characteristics. A Medicare patient must be homebound and in need of skilled intermittent nursing care or physical or speech therapy. Their care must be at a level requiring only part time or intermittent services. They must be either over age 65 or permanently and totally disabled for at least 30 months.

• The appropriate care for non-Medicare patients may not equate with Medicare's definition of "skilled care." For example, Medicare does not consider venipuncture (blood drawing) a qualifying skilled nursing service while Medicaid programs do. The frequency and duration of care may be significantly different for non-Medicare patients. In some cases, patients are receiving Medicaid-financed private duty nursing 24 hours a day, 7 days a week, which is not covered under Medicare. In general, the non-Medicare patient is significantly distinct from the types of patients receiving home health services covered under Medicare.

• In the absence of OASIS, the Conditions of Participation (COP) would still require that non-Medicare patients undergo a comprehensive patient assessment prior to the initiation of care. All patients must have a plan of care devised by the patient's physician and involving an inter-disciplinary group of health care professionals, such as nurses and therapists. This plan of care must be periodically reviewed and reassessed to meet changing needs of the patient. COP requirements regarding work force credentials, supervision and oversight, record keeping, case monitoring and management, and physician involvement would continue for both Medicare and non-Medicare patients.

Once again, thank you for introducing this important legislation. I would also like to commend Tim Raducha-Grace of your staff for his hard work on the issues addressed in this bill. Please contact me or Jeff Kincheloe of my staff if we can be of any assistance to you.

Sincerely,

Val J. Halamandaris
President

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