Home care groups work on unified IPS proposal


HHBR Washington Correspondent

WASHINGTON – Representatives from the five national home care associations met last week to draft a unified industry proposal for additional reforms in the interim payment system (IPS) for home health. The same five groups, the National Association for Home Care (NAHC; Washington), the American Federation of Home Health Agencies (AFHHA; Silver Spring, MD), Home Care Association of America (HCAA; Jacksonville, FL), Home Health Staffing and Services Association (HHSSA; Washington), and Visiting Nurses Association of America (VNAA; Boston), met in late January and "agreed to agree" on a unified proposal, according to one group present at the meeting.

While details of the legislation are being kept confidential until the actual legislative language is drafted, the association’s primary goals include these principles: 1) alleviate "unreasonable" IPS overpayment recoupment demands; 2) eliminate the 15% across-the-board cut in reimbursement now scheduled for Oct. 1, 2000; 3) increase per-visit cost limits; and 4) decrease the reimbursement disparity between high-cost and low-cost home health agencies. Taken together, one participant at the meeting said, these measures should enable providers to care for all patients by recognizing the higher costs incurred by treating medically-complex, long term care patients and act to prevent home care providers from having to discontinue participation in the Medicare program.

A week earlier, Sen. Charles Grassley (R-IA), chairman of the Senate Aging Committee, suggested that the prospects for further IPS reforms were remote absent such a unified approach. "I could not agree with him more," AFHHA Executive Director Ann Howard told HHBR last week. "It is absolutely essential that the five associations have one plan that we all support because we are only going to have one shot at it."

In fact, Grassley appeared to hold little hope for further reforms even if the industry is unified.

"(But) we strongly disagree," said HCAA’s Scott Lara. "We are going to be working very hard for further IPS reform. The devastation is so great out there with agencies forced into bankruptcy and patients forced into more costly alternatives." Lara said overpayment recoupments are forcing many agencies out of business and that any legislation must address that issue.

Last year, AFHHA, NAHC, and HCAA all sought relief from IPS through a moratorium in a largely unified fashion. HHSSA sought the same end, but pursued a slightly different approach, namely a split cap proposal. However, all sides agree the prospects for further reform are enhanced by the formal inclusion of both HHSSA and VNAA.