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Home Health & Hospice Week

Budget:

HOSPICES WIN MILLIONS IN STIMULUS BILL

Published on Tue Jan 20, 2009

But Medicaid cuts for many states are still rolling ahead.

Hospices have won back $135 million in Medicare funding for 2009, thanks to an uphill battle in the recently enacted economic stimulus bill.

Hospices' hopes were dimmed when the Senate did not include the measure, which delays the Budget Neutrality Adjustment Factor (BNAF) cut for one year, in its pared-down economic stimulus legislation. But when the Senate and House compromised on a bill to send to President Obama, the hospice provision made it in and the president signed it into law.

The achievement is "a significant victory,"the National Hospice & Palliative Care Organization cheers in a release. About "3,000 hospice provider jobs were threatened to be cut this year"due to the reimbursement reduction that took effect Oct. 1, 2008. Some hospice programs, especially small and rural ones, were in jeopardy as well,NHPCO notes.

The hospice industry gained the concession even after an unflattering, widely circulated Associated Press article that framed the legislative provision as the result of intensive special interest lobbying (see Eli's HCW, Vol. XVIII, No. 6, p. 47).

What now? NHPCO is meeting with the Centers for Medicare & Medicaid Services to"discuss the subsequent process necessary to address the one-year moratorium," the trade group reports.

Other stimulus bill provisions that affect home care providers are $87 billion in additional Medicaid funding and $19 billion for health care information technology advances. An amendment from Sen. Herb Kohl (D-Wis.) made sure home health agencies were eligible to receive the IT funds,according to a statement from the senator.

Medicaid Outlook Still Mixed

The Medicaid cash infusion appears to already be saving home care from cuts in some states. South Carolina's Department of Health and Human Services has pulled back a widely criticized plan to cut Medicaid hospice coverage in the state.The cut would have saved the state $1.5 million through June.

"We are elated by this decision," Renee Martin with Harmony Care Hospice in Columbia told AP. "This is so much more than budget numbers on a sheet of paper. This is about people in their most fragile time of life, the sick, and the poor."

And California will scrap pay cuts for statefunded home care aides if its share of the stimulus pie is big enough, reports the Sacramento Bee.

Major cuts: But other states are still planning on going ahead with cuts to home care funding. Most notably, New York Gov. David Paterson has proposed cutting home care payments up to $445 million, when matching federal funds are included.

The stimulus funding won't change that proposal,Paterson says. "This funding does not absolve us of our responsibility at the state level to bring spending in line with what our government can afford over the long term," Paterson says in a release. "This federal stimulus legislation does not in any way diminish the need to reevaluate our operations and produce a smarter, less costly, more efficient government."

Paterson wants to cut Medicaid reimbursement rates between 1.5 and 3.5 percent for certified home health agencies and long-term home health programs, AP says. He would apply an across-theboard 1 percent cut to all Medicaid rates, eliminate an inflation-based increase in payments to HHAs, and impose a 0.7 percent tax on revenues.

Under the cuts, smaller providers would see thousands of dollars less each year, and larger ones would face multimillion-dollar losses, according to the Home Care Association of New York State.

Connecticut is considering a cap on home care spending, New York counties are contemplating cuts to their home care programs, and South Carolina counties plan to cut programs that keep seniors out of nursing homes, like Meals on Wheels,according to news reports. The lack of caregiver support services is leading to an increase in elder abuse, adds the Boston Globe.

Exception: But some states are getting creative to plug the spending gap. For example, the Arkansas legislature recently voted to increase cigarette taxes to fund home care and other health programs,reports the Arkansas Democrat-Gazette.

And some states are taking the long view.Montana is considering increasing its home care services to save on nursing home costs, reports the Missoulian. The state may put another $10 million over two years into the program.

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