Congress studies reforms of venipuncture, IPS
Congress studies reforms of venipuncture, IPS
Both houses have bills in the works
The National Association for Home Care (NAHC) in Washington, DC, is asking Congress to pass bills that would repeal the Medicare venipuncture change and change the interim payment system (IPS) requirements. NAHC describes pending legislation as follows:
r HR 2912, the "Medicare Venipuncture Fairness Act." Introduced by Rep. Nick Rahall (D-WV), this bill would repeal the current restriction on venipuncture and require a study to examine the appropriate use of the venipuncture benefit. The bill has 100 cosponsors.
r HR 3137, the "Medicare Venipuncture Seniors Protection Act of 1998." Introduced by Rep. Robert Aderholt (R-AL), this bill would delay implementation of the restriction on venipuncture until Aug. 5, 1999, and it calls for a study to examine the Medicare venipuncture home health benefit. The bill has 41 cosponsors.
r S 1580, the "Medicare Venipuncture Assessment Act of 1998." Introduced by Sen. Richard Shelby (R-AL), this bill would delay implementation of the restriction on venipuncture until Aug. 5, 1999. It also calls for a study to examine the Medicare venipuncture home health benefit. This is a companion bill to HR 3137. It has 17 cosponsors.
r HR 3162. Introduced by Rep. Wes Watkins (R-OK), this bill would delay the implementation of IPS until Oct. 1, 1998. The bill has 13 cosponsors.
r HR 3108. Introduced by Rep. Jim Saxton (R-NJ), this bill would alter the calculation of payment under IPS by changing the base year from fiscal year 1994 to calendar year 1994. Also, the bill would not freeze in costs from 1994 to 1995, as mandated by the Balanced Budget Act of 1997. The bill has three cosponsors.
r HR 3651, "Medicare Home Health Agency Act of 1998." Introduced by Rep. Eliot Engel (D-NY), this bill would make a number of changes to IPS, including:
- modifying the per-visit cost limits to 110% of the mean in fiscal year 1998, then 107% thereafter;
- modifying the annual per-beneficiary cost limits to a blended rate based on 75% on the national average costs per beneficiary for cost reporting year 1995 and 25% on the average cost per beneficiary in the state in which the agency is located for cost reporting year 1995;
- establishing an "efficiency standard" and limiting future reductions in the Medicare home health benefit to the amount needed to achieve the original savings set by the Congressional Budget Office at the time the Balanced Budget Act was enacted.
The bill has 24 cosponsors.
r HR 3205. Introduced by Rep. James McGovern (D-MA) and Rep. Merrill Cook (R-UT), this bill calls for a delay in IPS until Oct. 1, 1998. It also would change the base year for IPS calculation to fiscal year 1995 or, at the election of the home health provider, calendar year 1995. The bill has 59 cosponsors.
r S 1643. Introduced by Sen. Edward Kennedy (D-MA) as a companion bill to HR 3205 in the Senate, this bill has seven cosponsors.
r HR 3567, "Medicare Home Health Equity Act of 1998." Introduced by Rep. Mike Pappas (R-NJ), this bill would make a number of revisions to IPS, including the following:
- change the calculation of the per-beneficiary limit to 75% national average costs per patient in fiscal year 1994 and 25% regional average costs per patient in fiscal year 1995, with an additional payment for outliers;
- restore the per-visit cost limits to 112% of the mean.
The bill has 81 cosponsors.
r S 1993, "Medicare Home Health Equity Act of 1998." Introduced by Sen. Susan Collins (R-ME), this bill would make the following changes to IPS:
- restore the formula for calculating the per-visit cost limits to 112% of the mean, rather than 105% of the median;
- amend the method for calculating the aggregate annual per-beneficiary limit under IPS to a blend of 75% of national average cost per patient and 25% of regional average cost per patient;
- include an outlier provision similar to the one implemented during the phase-in of the hospital prospective payment system.
The bill is the Senate companion to HR 3567. It has 20 cosponsors.
NAHC's recommendations for IPS
William A. Dombi, vice president for law and director of the Center for Health Care Law at NAHC, testified before a U.S. Senate Special Committee on Aging on March 31. He made these recommendations for IPS:
r Congress should delay the implementation of the per-beneficiary limits until fiscal year 1999.
r Congress should change the base year from a 12-month cost report ending fiscal year 1994 to the 12-month cost report ending calendar year 1995. Congress should also change the per-beneficiary limit calculation in IPS from 98% to 100% of the base year cost per patient.
r Congress should change the mandatory Oct. 1, 1999, 15% reduction in the limits to a reduction of up to 15% based on the targeted expenditures for home health during that year.
r Congress should allow the full market basket increase in calculating the per-beneficiary limits.
r Congress should require that the Health Care Financing Administration in Baltimore use the prorating provision only in situations where agencies are transferring or prematurely discharging patients for purposes of intentionally circumventing the limits.
r Congress should extend authorizations for exemptions and exceptions to the per-beneficiary limits.
r Congress should assign new providers a per-beneficiary limit that is the median of the limits for the census division where the agency is located.
r Congress should, at a minimum, maintain periodic interim payments until a prospective payment system is enacted.
[Editor's note: For more information about the pending legislation, you may contact NAHC at (202) 547-7424 or visit NAHC's Web site at http://www.nahc.org.]
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