HCAA urges immediate action on IPS and appeal process

HHBR Washington Correspondent

WASHINGTON – The Home Care Association of America (HCAA; Jacksonville, FL) used the House Ways and Means Health Subcommittee hearing on beneficiary and provider appeals April 22 to voice its concerns over what it considers an inadequate appeals process for home health claims as well as more far-reaching challenges facing the industry.

In testimony submitted to the subcommittee, HCAA Chairman Dwight Cenac urged Health Subcommittee Chairman Rep. Bill Thomas (R-CA) to schedule immediate hearings on the interim payment system (IPS) for home healthcare. "At last count, over 2,000 home health agencies have been forced out of business, causing the patients of those agencies to be forced into more costly nursing homes, more costly emergency rooms, or worse, left at home without receiving necessary patient care," asserted Cenac.

Unfortunately, Cenac’s appeal may have fallen on deaf ears — at least for the moment. House Ways and Means Committee and Senate Finance Committee staffers told HHBR last week that no hearings dealing with IPS have been scheduled so far this year.

"Congress maintains that there has been no interruption in services, but the question I have is, What happened to the patients of the 2,000 agencies that have gone out of business,’" argued HCAA Director of Government Affairs Scott Lara. He argued that many of them have opted for more costly institutional care.

Cenac said that the home health industry can not afford to await the outcomes of independent assessments by the General Accounting Office (GAO; Washington) or the Medicare Payment Advisory Commission (MedPAC) on the impact of IPS. MedPAC, an influential congressional advisory body, is scheduled to complete its report next month.

The HCAA Chairman further argued that HCFA’s recent troubles with OASIS data collection effort make it ever more likely that the agency will not be able to implement a prospective payment system (PPS) for home health care by the Oct. 1, 2000 deadline.

"It is imperative that you ask HCFA Administrator Nancy Ann Min-DeParle if indeed HCFA will be able to implement PPS for home health care on Oct. 1, 2000," argued Cenac.

Cenac also recommended that Thomas query DeParle about the implementation of PPS for skilled nursing facilities (SNF). A HCFA town hall meeting on the SNF PPS at the agency’s headquarters in Baltimore on April 23 revealed widespread belief that that system has left numerous facilities teetering on the edge of bankruptcy and financial organizations largely unwilling to consider any further investment in these facilities.

In the area of appeals, Cenac protested the ability of the HCFA administrator to overturn the decisions of an Administrative Law Judge when they are in favor of home health providers. He said home health agencies have been under "an unrelenting attack by the fiscal intermediaries regarding costs" but argued these same fiscal intermediaries are not using the concept of reasonableness when conducting audits.

"HCFA must reinstate the waiver of liability’ to home health agencies who are complying with laws and regulations," said Cenac. "The us versus them’ mentality at HCFA, the intermediaries, and the surveyors must be replaced by the concept of reasonableness between surveyors, fiscal intermediaries, HCFA, and home health providers when dealing with audit and compliance issues."