HHSSA urges HCFA to impose regulatory moratorium until PPS


HHBR Washington Correspondent

WASHINGTON – The Home Health Services and Staffing Association (HHSSA; Washington) is urging the Health Care Financing Administration (HCFA; Baltimore) to impose a one-year moratorium on all regulations that may apply to Medicare participating home health providers until the prospective payment system (PPS) has been implemented, unless the regulations are necessary for PPS.

Similar to the other national trade groups, HHSSA urged HCFA to increase the initial payment included in the proposed rule from 50% to 75% and to eliminate the low utilization payment adjustment (LUPA) pending further analysis in its comments on the agency’s proposed rule.

HHSSA commended HCFA for moving forward to meet the Oct 1, 2000, statutory deadline for prospective payment for home health agencies. But the association added that the conversion of home health services covered by Medicare from cost reimbursement to prospective payment represents "the most significant change in the benefit in the nearly 40-year history of the program.

"The conversion of all patients, all services, and all providers to the new system simultaneously overnight on Sept. 30, 2000, is unprecedented and will require a massive and focused commitment of resources by HCFA, the intermediaries, and providers if interruptions of medically necessary services to beneficiaries are to be avoided," HHSSA said.

The association added that because Congress delayed the effective date of the 15% additional reduction in reimbursement after the proposed rule was published, its comments must be considered tentative.

"The postponement of the effective date of that additional cut and additional adjustments in the prospective payment rates that HCFA is contemplating will likely result in significant changes in the payment rates under the new prospective payment system," argued HHSSA.

HHSSA is urging the agency to publish a notice in the Federal Register with an opportunity for public comment that includes the best estimate of the prospective payment rates, absent the 15% reduction. "It is difficult, if not impossible, to provide educated comments on the effect of the new reimbursement rates on the home health benefit when the rates that have been proposed may be significantly different from the ones that are used," said HHSSA.

The association also argued that a mechanism should be installed to prevent interruptions in payments during the transition to PPS and that medical review should be suspended for at least the first 90 days of PPS. In addition, HHSSA said the collection of OASIS data should be restricted to Medicare patients and the 19 questions needed for implementing PPS.

"We now know that only 19 of the approximately 80 questions on the OASIS form are necessary for implementation of PPS," said HHSSA. "While we recognize and support outcomes research, the highest priority should be given to the transition to PPS."