Subcommittee sympathizes with complaints from providers

By MATTHEW HAY
HHBR Washington Correspondent

WASHINGTON – The Senate’s Permanent Subcommittee on Investigations heard from a panel of home care providers last week that the Balanced Budget Act of 1997 (BBA) has imposed payment and regulatory requirements the home care industry simply cannot sustain. "The numerous changes and regulations promulgated since the passage of the BBA have been complex, ambiguous, and often costly," said the Visiting Nurse Associations of America’s Maryanna Arsenault at the June 10 hearing. She added that "implement and suspend" has become the norm for HCFA, and even though it rarely meets regulatory deadlines itself, there is zero tolerance for error on the part of home health agencies.

Those pleas did not fall on deaf ears. "In trying to get a handle on costs," said Subcommittee Chairwoman Sen. Susan Collins (R- ME), "Congress and the administration created a system that penalizes efficient agencies and that may be restricting access for the very beneficiaries who need care the most – the sickest patients with complex, chronic care needs." She called the interim payment system (IPS) for home health critically flawed because it effectively rewards the agencies that provided the most visits, while it penalizes low-cost, more efficient providers and their patients. Collins was not alone. Sen. Pete Domenici (R-NM), who also heads the Senate Budget Committee, accused HCFA of a pattern of "over-regulation" that has left the home care industry "entangled in a web of new rules."

When it was her turn, HCFA Deputy Director Kathy Buto ceded little ground, however. She said that prior to the changes imposed by the BBA, the Medicare home health benefit was growing at "an unsustainable rate" and was ripe with waste, fraud, and abuse. She credited the BBA with eliminating "unnecessary and uncovered services" and "creating incentives to deliver care efficiently." Buto also said HCFA’s anti-fraud efforts are having an enormous impact. Her only concession before the panel was announcement of a three-month grace period for HCFA’s 15-minute reporting requirement scheduled to take effect July 1 (see related story, page 2).

Collins’ staff told HHBR that she plans to introduce legislation shortly that will address many of the other areas addressed during the hearing.