HCFA clarifies 15-minute rule as industry presses for repeal

HHBR Washington Correspondent

BALTIMORE – The Health Care Financing Administration (HCFA; Baltimore) recently handed home care representatives a 16-item, frequently asked questions guide that addresses various areas of the 15-minute reporting requirement home health agencies will have to begin using Oct. 1. For example, medical documentation that takes place in the home can be included, and minor interruptions (roughly three minutes) should not be excluded from the reporting requirement. HCFA also emphasized that the new rule is "a reporting requirement and not a payment requirement" and that covered administrative costs performed outside the home should continue to be included in annual cost reports.

But home care representatives maintain the new rule is non-sensical and that the congressional intent behind it is still unclear. Many are hoping that the recent delay in the effective date of that rule is merely the precursor to its elimination.

"I am just thankful that they are injecting some common sense," said one industry representative referring to the delay. "Maybe the surety bond fiasco last year brought home the point that they don’t want to be taken to the congressional woodshed every time a regulation comes down for home care . . . Congress knows the squeeze from reimbursement is bad enough without the increased regulatory burdens and regulatory costs on top of that."

"Nevertheless," another aide added, "you are talking about systems here, and I’m sure there were agencies that were already buying software and training their staff to think in 15-minute increments because it is not as though you can flip a switch and just make this happen."

But industry representatives seeking to have the measure repealed say the problem lies not with HCFA, but with Rep. Bill Thomas (R-CA), chairman of the House Ways and Means Health Subcommittee. "If there is a fault to be had, it belongs with Thomas because it is something that he wanted to do," said one representative.

Thomas reportedly believes that if a prospective payment system (PPS) for home health is not in place, a reimbursement method can be developed based on 15-minute increments. "But our thought is, Why not just sample agencies so the whole industry doesn’t have to subject themselves to this?’" the representative added. "Or conversely, Why not wait until HCFA has to report back to Congress in October about their progress on PPS and, if they are behind in their timetable, then think about implementing the 15-minute rule?’"

The aide said there are ongoing discussions with the Ways and Means Health Subcommittee staff to clarify the congressional intent behind the rule and hopefully to find an alternative. But the bottom line, according to the aide, is that there is a big fear factor among Thomas’ colleagues.

Legislation is also expected to be introduced in the Senate by Sens. Susan Collins (R-VT) and Kit Bond (R-MO) that would eliminate the 15-minute requirement.