Medicare Compliance & Reimbursement

Medicare bill a mixed bag for HHAs.  It will take experts months to suss out the recently passed Medicare bill's overall impact on home health agencies, thanks to its 1,000+ pages and hundreds of provisions. But at first blush, the massive piece of legislation has both good and bad news for HHAs. The Good News: No copay. The industry continues to celebrate its victory over the home health copayment that was proposed this session, and at one point looked inevitable. The bill, which President Bush signed into law Dec. 8, contains no mention of the much-hated proposal. Rural add-on. Although not as much as first proposed by the Senate, the one-year, 5-percent add-on for patients served in rural areas will add to agencies' bottom lines starting in April. Senate Finance Committee Chair Charles Grassley (R-IA) referred to payment increases to rural providers including HHAs as "dramatic improvements." Private-pay OASIS suspension. On the heels of Centers for Medicare & Medicaid Services Administrator Tom Scully's announcement that collection of OASIS data for non-Medicare, non-Medicaid patients was off, Congress passed a provision saying the same thing. The measure will chiefly help those agencies that serve many private-pay patients in addition to Medicare and Medicaid patients. The Bad News: Inflation update reduction. As expected, Congress passed a reduction of 0.8 percent to the home health market basket index, the factor used to update rates for inflation. The -0.8 percent factor will take effect in April, when HHAs will see their payment rates cut accordingly, and will continue through 2006. Inflation updates also will be moved from a federal fiscal year basis (starting in October) to a calendar year basis, trade associations report. Pennsylvania HHAs told the Wilkes-Barre Times Leader that the cuts in the legislation, estimated at $6.5 billion over 10 years, could force them to restrict services. "They're killing home health," said Debra Popovich, director of Personal Care Home Health Services in Kingston. "It's going to be very difficult." Background checks. "The most onerous components of the Senate-passed criminal background check legislation were eliminated or softened in the final Medicare bill," the Visiting Nurse Associations of America cheers in its summary of the legislation. But the remaining provisions still could cause HHAs headaches. Congress approved a three-year demonstration project that will take place in 10 states, requiring home health agencies, hospices, personal care providers, skilled nursing facilities and others to conduct beefed-up background checks on direct care employees. However, the legislation doesn't require HHAs to conduct or pay for the pricey FBI 10-fingerprint check; instead, it "permits" providers to conduct the checks, the VNAA notes. It does require providers to reference currently available registries for disqualifying information, however, points out the American Association [...]