House resolution would roll back surety regs

Members of Congress are continuing with their efforts to rein in the federal government's aggressive campaign against health care fraud and abuse, but whether the spate of recent bills and resolutions leads to any real victory for health care providers remains an open question.

In the most recent action, Rep. Jim Nussle (R-IA) introduced a resolution last week that would force the Health Care Financing Administration (HCFA) to put a hold on the Medicare home health surety bond regulations. Seventy-three other House members signed on to the resolution.

Nussle’s resolution mirrors one introduced a week earlier in the Senate by Sen. Christopher Bond (R-MO). Bond’s resolution asserted that HCFA's surety bond regulations, when combined with the Interim Payment System (IPS), threaten to cripple the ability of home health agencies to provide high-quality care.

According to an aide to Nussle, the resolution was immediately referred to the House Ways and Means Health Subcommittee. "Now it’s up the Health Subcommittee Chairman Bill Thomas [R-CA]," says the aide. Although there's no way of knowing exactly how quickly the Health Subcommittee might act on the resolution, it’s at least possible that some action will be taken before the July 4 recess, he adds.

HCFA issued a revised final rule on surety bonds earlier this month that failed to address many of the concerns of home care providers, including the need to waive liability for home health services provided in good faith and reimbursed after Jan. 1, 1998, and an exemption for home health agencies that are the sole participating provider in a specific geographic area but are unable to obtain bonds. (See Compliance Hotline's Special Bulletin: Final bond revisions maintain HCFA’s hard line, June 1.)

The growing effort to make significant changes in the surety bond requirements also gained momentum when Rep. William Jenkins (R-TN) and 73 House members told Thomas that while they support the elimination of fraud and abuse in the Medicare program, the home health industry should not be forced to bear "an unequal burden in the reform of the Medicare program."

Jenkins and his colleagues targeted not only HCFA’s "overreaching" surety bond regulations but implementation of the IPS and elimination of Medicare reimbursement of home health visits for the purposes of obtaining a blood sample, or venipuncture.

Jenkins asserts that while the IPS will be beneficial to home health agencies and beneficiaries if it is "properly implemented," the new IPS falls short of this by establishing per beneficiary caps based on data from 1993-94 and not allowing for changes over time in the patient mix of home health agencies. "In addition," Jenkins says, "the IPS cost limits are 105% of the median, which is 7% less than under the old payment system" and "on Oct. 1, 1999, home health agencies are scheduled to suffer an additional cut of 15% in reimbursements from Medicare."

"Further modifications[s] are needed to reform the Interim Payment System and accelerate the transition to a final Prospective Payment System," Jenkins concludes, "which adequately and fairly compensates home health providers and assures their patients the best quality care at the lowest possible price."

While encouraged by measures in the House and Senate, many industry veterans continue to view the surety bond regulations and IPS as efforts to slash home care spending. "HCFA never liked home care," concludes one industry veteran. "I expect to see a continued wave of similar efforts that will continue to ratchet down reimbursement on the entire industry."