Home health provisions pass House and Senate

With surprising alacrity, the Senate voted to pass the Budget Reconciliation Act July 31, 1997, the day after the bill passed the House of Representatives. The Senate vote was 85-15. The House passed the legislation 346-85.

Here are the home health provisions, including the patient freedom of choice amendment, that likely will get President’s Clinton’s signature:

• Home health benefits will be shifted from Part A to Part B of Medicare, except for 100 visits per spell of illness after three-day hospital or nursing home stay (or 100 visits post-hospital).

• Part B premium will be increased to cover costs of transferred home health services, on top of other scheduled increases in Part B premiums.

• Beginning Oct. 1, 1997, home health agency reimbursement will be set at the lower of: (1) cost caps set at 105% of the median (down from 112% of the mean); (2) allowable per visit cost; or (3) agency-specific average per patient cost of providing services to beneficiaries in cost reporting year ending in 1994, multiplied by the unduplicated number of patients in the current year.

• Cost limits will reflect no increase in the cost of providing home health services during the cost reporting periods beginning on or after July 1, 1994, and before July 1, 1996.

• Payment rates will be based on location of patient residence rather than location of the home health agency.

• PPS will be developed by HHS Secretary by Oct. 1, 1999; pure per episode case mix methodology will be used; there must be a 15% reduction in reimbursement from what expenditures would otherwise be with continuation of cost reimbursement.

• There will be no administration or judicial appeal of payment method, computations, or rates in PPS system developed by HHS/HCFA.

• Patient visits that exceed normative standards for duration and frequency of services, to be developed by the Secretary of HHS for Oct. 1, 1997, implementation, will be denied.

• Patients needing only venipuncture are not eligible for home health benefit, effective six months after enactment of legislation.

• All home health claims will include information on visit length in 15-minute increments, beginning Oct.1, 1998.

• Periodic interim payment will be implemented with implementation of PPS.

• Home health agencies will be required to purchase surety bonds of at least $50,000.