Home Health & Hospice Week

Revisit fees, hospital transfer changes could affect your home care organization.

In addition to Medicare cuts, President Bush called for other fiscal year 2009 budget measures that would affect home care providers: • Revisit fees. The administration wants to raise $35 million in 2009 by reinstituting revisit survey fees. The Centers for Medicare & Medicaid Services "would charge revisit user fees to health care facilities cited for deficiencies during initial certification, recertification or substantiated complaint surveys," explains a summary of Department of Health and Human Services budget provisions. "This fee will build greater accountability into the survey and certification program and create an incentive for facilities to correct deficiencies and ensure quality of care." • Medicaid. The President calls for a nearly $2 billion cut to Medicaid in 2009 and a $17 billion cut over five years. None of the Medicaid cuts impact home care directly, but the reductions could "weaken the states' ability to provide these much-needed services," fears the National Association for Home Care & Hospice. • Hospital transfer expansion. Home health agencies already have felt the hospital referrals pinch resulting from CMS' policy requiring proration of hospital episode payments when the patient is discharged to home care too early (for transfer policy details, see Eli's HCW, Vol. XVI, No. 40).

The administration wants to "increase the inpatient length of stay threshold that triggers transfer payment adjustments," the summary notes. That could lead hospitals to restrict home care referrals even further. • Hospice. The budget seeks to phase out the hospice-specific wage index over three years and require more frequent hospice surveys, the National Hospice and Palliative Care Organization points out. • Site-neutral payments. A provision that could benefit HHAs, at least in the long run, is site-neutral payments for post-acute care. The measure would "limit inappropriate incentives for five conditions commonly treated in both skilled nursing facilities and inpatient rehabilitation facilities," the budget summary notes. That might drive more patients into home care rather than institutional settings. v

Note: The HHS budget summary is at www.hhs.gov/budget/09budget/2009BudgetInBrief.pdf --the CMS section starts later in this issue.