Homecare Industry Presents United Voice on Capitol Hill

The American Association for Homecare (AAH) held its second annual conference Feb. 14 and 15 at the Loews L'Enfant Hotel in Washington, D.C. Although congressional visits were the top priority of the day, participants took advantage of timely educational programs, such as a session on complying with the Health Insurance Portability and Accountability Act (HIPAA). Attendees also took an opportunity to learn the latest on the industry's legislative agenda and how to advocate for quality health care services at home.

During his opening remarks, AAHomecare Chairman Don White reminded members to show appreciation to members of Congress for AAH gains made this year but that Congress needs further education -- particularly on the need for a full CPI update for durable medical equipment providers (DME) in 2002 and the elimination of the 15 percent cut in the home health benefit.

"This is an exciting time for the homecare industry and AAHomecare. Congressional leaders have signaled their willingness to enact Medicare reform this year. Homecare has to be at the table for this discussion, and we must be prepared to shape the role that we want to play," White said.

AAHomecare's conference showcased a series of presenters, including members of Congress, key committee staff and representatives from the Health Care Financing Administration (HCFA), who provided insights into the major issues that Congress will be wrestling with this legislative session. Topping those priorities were Medicare reform and the creation of a


The big question will be how much is HCFA willing to do on their own and what will need to be legislated.
prescription drug benefit. Although all the presenters shared common priorities, they varied greatly on the procedure for accomplishing these goals. Some presenters stated that, although market-based reforms should be set in place to help improve the system, Medicare beneficiaries should not be penalized for choosing the traditional fee-for-service program. Other presenters declared that reforms should be targeted only toward beneficiaries that need it the most and to reach everyone in the program.

While there was considerable agreement for Medicare reform, there was a unanimous sentiment that HCFA reform is needed as well. Rep. Richard Burr (R-NC) said, "The big question will be how much is HCFA willing to do on their own and what will need to be legislated." Others concurred and said they believe that the Bush administration will undertake reorganization of HCFA through it own administrative procedures.

Congressional staff member Tom Walsh from the office of Sen. Charles Grassley (R-IA) said that the Senate Finance Committee interviewed all 19 members about their legislative priorities. While many expressed interest in Medicare reform, none expressed interest in providing any givebacks. But AAHomecare President Thomas Connaughton added, "Although we heard that Congress would focus on Medicare reform and not legislative relief in the form of givebacks, we heard the same thing last year, yet, we were able to secure significant relief for our industry. This was a direct result of our unified voice on Capitol Hill last year, which we will enhance even further this year."

During an update on HCFA's activities, Bob Wardwell, director of the division of community post acute care, recognized that he could not speak to the exact priorities for HCFA this year because the new leadership had not yet been selected. He noted however, that HCFA has been busy working on the release of program memorandums related to the Medicare, Medicaid and SCHIP Benefits Improvement and Protection Act of 2000 (BIPA). Wardwell explained that HCFA is still working to refine the home health PPS and identified two areas of concern -- the complexity of


This is an exciting time for the homecare industry and AAHomecare.
remittance advice and difficulties with Medicare summary notices. Wardwell announced that HCFA is still continuing work on the Inherent Reasonableness (IR) Final Rule, providing no date for its release. Wardwell also made himself available for a number of one-on-one questions with attendees.

AAHomecare invites homecare suppliers and providers to add their voices to the messages the association is advocating on Capitol Hill. AAHomecare is building a community of support for the value of quality, cost-effective, patient-preferred health care services at home.

As part of its mission to make it universally possible for individuals with both acute and chronic conditions to receive high quality medical care at home to the maximum extent technologically feasible. To this end, the following issues are the association's top legislative priorities.

Medicare access must be restored to beneficiaries eliminated from the home health benefit as a result of the Balanced Budget Act of 1997 (BBA'97) by eliminating the 15 percent cut for home health services scheduled for Oct. 1, 2002. Full elimination of the additional cut is essential in order to avoid further reductions in access to covered services for the most vulnerable Medicare beneficiaries. Sens. Susan Collins (R-ME), Christopher Bond (R-MO), Jack Reed (D-RI) and John Kerry (D-MA) have introduced a bill (S.236) that would eliminate the pending 15 percent payment cut to the Medicare home health benefit and provide an extension of the 10 percent add-on for rural home health agencies. The homecare industry needs to put their support behind this bill by contacting their legislators and educating them about the need for enacting this bill.

The cost of living adjustment for home medical equipment for fiscal 2002 must be restored. Income from Medicare was not only cut 30 percent for home oxygen by BBA'97, but all income for Medicare home medical equipment and services has declined in real terms in the absence of the Consumer Price Index (CPI) adjustment. Labor and fuel costs also have continued to increase further straining the industry's ability to provide quality equipment and services to patients.

Medical supply coverage should be refined under the consolidated billing requirement for the Prospective Payment System (PPS). The bundling for non-routine medical supplies into the home health agency PPS rate and consolidated billing for these supplies ignores the inherent complexities of the home health market and threatens the continuum of care for individuals with chronic health care needs who require additional acute care for a period of time. Bundling and consolidated billing would require the company providing maintenance supplies to cease serving the beneficiary and make the home health agency responsible for the supply function. This change in medical supply providers results in placing unnecessary burdens on patients and caregivers when they need it least.


While there was considerable agreement for Medicare reform, there was a unanimous sentiment that HCFA reform is needed as well.

HCFA must be closely monitored and directed to implement Inherent Reasonableness (IR) in a rational manner and develop a statistically reliable data collection methodology. Historically, HCFA and its regional carriers have used statistically invalid and non-representative data to justify reimbursement reductions above and beyond the limit imposed by BBA'97. Any further reimbursement reductions by HCFA and its carriers will seriously curtail a beneficiary's access to medically necessary equipment and services.

Medicare reform should include the following principles:

Access Medicare beneficiaries should have timely access to medically necessary homecare items and services. Medicare coverage policy, national and local, should aim to provide beneficiaries access to appropriate technology and therapies in their homes rather than to control utilization. Funding for homecare should be sufficient to assure adequate access to medically necessary homecare for all beneficiaries. Regulatory oversight of homecare should be reasonable and not overly burdensome to beneficiaries or providers and suppliers.

Choice Medicare beneficiaries should be guaranteed the freedom to choose their homecare provider/supplier. The association believes that the ability to freely choose a healthcare provider/supplier will guarantee access to high quality homecare items and services. Moreover, Medicare beneficiaries should retain the right to choose "upgraded" items and services when they are willing to pay more than the Medicare allowable.

Fairness Medicare beneficiaries and the providers or suppliers that serve them should receive timely notice and an opportunity to comment on changes in Medicare policy that will affect coverage and reimbursement. Medicare beneficiaries should be able to seek and obtain timely prior authorization for homecare items and services and should receive timely decisions on appeals of Medicare coverage decisions and claim denials.

Accessibility Information about Medicare coverage criteria and payment policies should be comprehensive, readily available and easy to understand. Beneficiaries and the homecare providers or suppliers who serve them should not be burdened with unwieldy documentation requirements for determining eligibility, coverage or payment requests.

This article originally appeared in the April 2001 issue of HME Business.

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