Small Business Administration working for small agencies


HHBR Editor

The Small Business Administration (SBA; Washington) has been working hard for small home care agencies since the inception of the Balanced Budget Act of 1997 (BBA) turned the entire home healthcare industry upside down. And SBA Chief Counsel for Advocacy Jere Glover says while the administration has been successful in some regard, there is still a lot pending and still a lot that has not been done.

"One of the principal issues is still the reimbursement of and the way (the Health Care Financing Administration; HCFA; Baltimore) is dealing with small home care agencies," Glover said. "That has been a rocky road for the last few years."

Glover said the new regulations brought on by the BBA have put many small agencies out of business. "It’s a significant challenge and not unusual for a few bad apples to cause problems for everyone, and in their care, the government overreacted to some isolated cases," Glover said. "We have to refocus their attentions on the problems, but not hurt others who are providing good services."

The SBA has been highly involved in filing comments involving home care, Glover said. "About a year and a half ago, the SBA Office of Advocacy’s comments on the surety bond issue spurred Sen. Christopher Bond (R-MO) to introduce a resolution of disapproval that would have vetoed the regulation," Glover added. "Instead, HCFA withdrew the regulation, and the (General Accounting Office; GAO) did a study that indicated the impact would have fallen squarely on the shoulders of small businesses. HCFA is redesigning the surety bond program accordingly."

And, according to the SBA’s Annual Report on the Regulatory Flexibility Act, HCFA is consulting with Advocacy in the early stages of current regulatory issues. In the past year alone, HCFA consulted with Advocacy on at least two occasions involving major regulations prior to formal proposal, the report said. Part of the impetus for these remarkable changes stemmed from the comment letter and other early action that Advocacy undertook on surety bonds for home health agencies, the SBA claims.

If patients don’t get these services at home, the government pays more to give them at a hospital or facility, Glover said. "That’s the challenge, but we still haven’t reached our goals in making sure agencies understand that. We have found some marginal successes, but are not where we should be."

Looking forward, Glover said, "the SBA is having some research done right now on HMOs’ discrimination of small businesses. That report is not in its final form yet," he said.

"The bottom line is that the home health industry has helped balance the budget, but it has helped too much," Glover said. "The decision to restrict the amount of money going to home care agencies went too far."

To the small agencies still out there hanging on, Glover said to be sure to plan long term. "I think those that can survive the next year or two will do all right," he said. "The problem is getting through this critical period."