Bill to increase home care payments introduced in House

HHBR Washington Correspondent

WASHINGTON – Legislation that would gradually increase per-beneficiary caps, increase the limit on the number of visits allowed, and repeal the scheduled 15% across-the-board cut in home health payments was introduced in the House last week.

The Home Health Access Restoration Act, introduced by Rep. Bill Coyne (D-PA) June 16, was the second major home care bill introduced in Congress this year. But congressional aides tell HHBR that more bills are on the way. An aide to Sen. Susan Collins (R-ME) confirmed last week that Collins is currently working on a bill that includes many of the provisions contained in Coyne’s bill. Sen. Jim Jeffords (R-VT), who heads up the Senate Labor and Human Resources Committee, is drafting the other bill expected to be introduced shortly.

Coyne’s bill would increase the per-visit limit to 110% of the median and permanently repeal the 15% cut in interim payment system (IPS) home health payments. It would also increase the per-beneficiary limit for agencies with limits under the national average to 90% of the national average in 1999, 95% in 2000, and 100% in 2001. In addition, it would cap payments to providers at 250% of the national average in 1999, 225% in 2000, and 200% in 2001.

The legislation would also provide protection from inappropriate discharge by requiring that Medicare beneficiaries receive a notice of discharge similar to the one provided to Medicare+Choice hospital patients and require the Health Care Financing Administration (Baltimore) to provide information to physicians about how IPS affects their patients.

Coyne said that the PPS will set reimbursement payments that reflect the actual costs of providing those services, but that the IPS has caused "serious problems" in states such as his own where home heathcare costs were below average. "In Pennsylvania, where home healthcare costs and visit frequency have always been lower than the national average, the average patient receives nursing assistance less often, and 6,100 home care workers have been laid off," he said.

According to Coyne, since the IPS capped payments based on individual provider spending in 1994, agencies with the lowest costs were given the lowest caps. "Since many of these agencies had already trimmed the fat from their operations, they are now being forced to lay off nurses and cut services," he said. "The IPS caps on payments for home health services mean that agencies can’t afford to provide Medicare beneficiaries with the services they need and to which they are entitled."

That view reflects the fact that many members of Congress were not swayed by the General Accounting Office’s (GAO; Washington) recent study, which concluded that beneficiary access to home health services has not been hurt by IPS.

Coyne, who is a member of the House Ways and Means Health Subcommittee, estimated that his bill would restore about eight of the skilled nursing visits that the average patient has lost and ensure that agencies can afford to provide a full range of physical therapy and skilled nursing.

His bill would also require the GAO to complete a study on the value of home care to the Medicare program. Specifically, it would require the GAO to determine whether cuts in home health spending are driving up the cost of more expensive government healthcare programs, such as Medicare inpatient hospital stays and Medicaid nursing home reimbursement.