August 30, 2000
Dear Colleague:
As the closing weeks of the 106th Congress come upon us, we would like to ask your support for the most frail and fragile of our constituents: home care beneficiaries.
Throughout the past several months, we have been working with all five of the national home care advocacy groups -- the American Association for Home Care, the American Federation for Home Care Providers, the Home Care Association of America, the National Association for Home Care, and the Visiting Nurse Associations of America -- in crafting legislation which addresses the most vital home care issues for this year, including the elimination of the scheduled 15% cut in Medicare home health outlays. As a result of this collaborative effort, we will be introducing the Home Health Refinement Amendments of 2000 upon Congress reconvening next Wednesday, September 6. A summary of the bill is also attached.
Support for this bill is critical as Congress considers any Medicare refinement legislation in the final weeks of the session. Together, we have the ability to ensure that our home care providers and the patients they serve are not left unspoken for in any such "giveback" bill.
Should you wish to become a co-sponsor of this legislation or join us in our press conference, please contact Jeff Vorberger (Peterson) at 5-5121, Keith Stern (McGovern) at 5-6101, or Jack Zylman (Hilliard) at 5-2665.
Sincerely,
| /s/ John E. Peterson M.C. |
/s/ James P. McGovern M.C. |
/s/ Earl F. Hilliard M.C. |
The Home Health Refinement Amendments of 2000 provide real relief for home health agencies across the country. This bill will allow agencies to stay solvent, provide needed care to home health patients and encourage the continued use of cutting edge technology in order to practice home health care away from home. This bill is an important step to strengthening home health care in the 21st Century.
Specifically, the Home Health Refinement Amendments of 2000 addresses five separate areas:
This provision eliminates the additional 15% cut in home health spending mandated by the Balanced Budget Act of 1997. This cut is scheduled to be implemented on October 1, 2001. Home health spending has been cut by 45% over the first two years of the BBA. The BBA was projected to cut $16 billion for Fiscal Years 1998 through 2002. However, in just two years, Medicare saved $53 billion in home health care spending. Home health services have been reduced from 9% of the Medicare program to 4%, and almost 890,000 Medicare beneficiaries lost home health services since 1997.
This provision adds 10% to the base payment under the Prospective Payment System (PPS) for patients in rural areas and reimburses providers for the costs of security services in high-risk areas. Studies show that delivery of home health services in rural areas is 12 to 15% more costly than average. This 10% add-on to the base payment for rural agencies will help insure care for needy beneficiaries in rural areas by easing the fiscal burden of agencies to treat these patients. Many agencies operate in high-risk areas and must provide security services to ensure the safety of their home care workers. This provision would reimburse these agencies for the costs of providing such services. The costs eligible for reimbursement would be determined by the Secretary of Health and Human Services, implemented nine months after the date of enactment of the bill.
This provision provides additional funding for "outliers" under the prospective payment system. The funding level for outliers would be set at 10% of the total payments projected or estimated to be made under the prospective payment system each year. This would double the current 5% allocation, and the added portion of the outlier pool would not be subject to the budget neutrality factor and would not reduce the base payment. It is anticipated that this would restore about $500 million a year to home health services over the next five years.
This provision would remove the costs of non-routine medical supplies from the PPS base payment and pay for these supplies on a fee schedule. Since the PPS base payment would be reduced as a result of the exclusion of medical supply costs, this provision would be budget neutral. This provision is essential because PPS rates include the average medical supply costs, but some agencies' patient populations have greater or lesser medical supply needs. The current rates would underpay agencies that treat these vulnerable populations and overpay agencies that treat patients with low medical supply needs. Agencies that treat patients with complex medical needs should not be punished with low rates.
This provision allows home health care agencies to list tele-homecare services on their Medicare cost reports and mandates a study to examine the role of telemedical care in providing home health care services. Telemedicine services are expanding into all realms of health care and many home health care agencies provide care through telemedicine. Medicare does not currently reimburse agencies for providing care via telemedicine. This provision would not provide such a Medicare reimbursement. However, agencies will be allowed to list the telemedicine services provided in the event that HCFA, in the future, provides reimbursement for these services. This provision also mandates a study to make recommendations about making tele-homecare visits equivalent to face-to-face visits for purposes of establishing eligibility or qualifying for outlier or low utilization payments (LUPAs) under the new Prospective Payment System (PPS).
REPUBLICAN CONTACT:
Jeffrey Vorberger
Legislative Assistant
Rep. John E. Peterson
307 Cannon Office Building
Washington, D.C. 20515
(202)225-5121 (tel); (202) 225-5796 (fax)
DEMOCRATIC CONTACT:
Keith Stern
Legislative Assistant
Rep. James P. McGovern
416 Cannon Office Building
Washington, D.C. 20515
(202) 225-6101 (t)/(202) 225-5759 (f)