2000 NAHC Legislative Blueprint for Action

INTRODUCTION

The 2000 Blueprint for Action represents our legislative agenda for the National Association for Home Care (NAHC). This book contains a discussion of the Association's priorities and other important issues and recommendations concerning home care and hospice. It was prepared through a series of meetings with home care and hospice professionals, and a survey of the NAHC members, reviewed by the Government Affairs Committee and approved by the NAHC Board of Directors at its January meeting.

The Blueprint is organized within sections according to the membership's priorities. All items in the Blueprint contain a discussion of the issues and the Association's recommendations concerning home care and hospice. The Blueprint reflects NAHC's continued dedication to ensuring that high quality home care and hospice services are fully available to all individuals in need.

The central goal of NAHC's legislative agenda is the humane, cost-effective provision of high-quality home care to all who require it, whether they are needy, infirm, elderly, children, or disabled. NAHC believes that quality home care and hospice are the right of all Americans. It believes that home care and hospice are both a humane and cost-effective alternative to institutionalization. Home care and hospice reinforce and supplement the care provided by family members and friends and encourage maximum independence of thought and functioning, as well as preservation of human dignity.

This document has been produced by the National Association for Home Care, a professional association that represents the interests of nearly 6,000 home health agencies, home care aide organizations and hospices, as well as the caregivers who every year provide services to more than five million Americans. It is hoped that this document will be helpful to the Congress in its deliberations and that it will result in the enactment of legislation to improve the quality of life for millions of Americans.

LEGISLATIVE PRIORITIES

The following issues will be the focus of the National Association for Home Care's (NAHC) legislative activities in the year 2000. Central to NAHC's mission is to preserve the integrity of the Medicare home health and hospice benefits, to broaden the availability of home care to different populations throughout the nation, and to protect the rights of both patients and providers.

MAINTAIN THE INTEGRITY OF AND STABILIZE THE MEDICARE HOME HEALTH AND HOSPICE BENEFITS.

1. Home health Prospective Payment System:
   
   
   • Congress must closely monitor development and implementation of the home health Prospective Payment System (PPS) to ensure that the overall home health budget and the individual case payments are sufficient to maintain access to care. Congress should develop a system of exceptions and exemptions from PPS to ensure access to care for high-cost patients and for those in medically underserved areas.
   • Congress should direct Health Care Financing Administration (HCFA) to adjust the overall home health budget and the payment rates for costs agencies incur in complying with regulatory and legislative requirements that were not included in the initial calculation of PPS rates.
   • Congress should require that HCFA issue an initial episode payment to the home health agency equivalent to 90% of the anticipated amount due to that agency for a particular beneficiary claim. Congress should also exempt home health agencies from the 14 day payment floor and mandate payment of interest on all claims submitted by home health agencies that are not processed within 30 days.
   • Congress should authorize home health agencies to utilize PPS payments in a flexible manner in order to achieve quality of care and efficiencies without adverse consequences relative to payment, coverage, and compliance with the conditions of participation.
     
     
2. Scheduled 15% cut in home health payments/Annual market basket updates for home health and hospice. Congress should eliminate the mandatory 15% reduction in home health reimbursement scheduled for one year following implementation of PPS. Congress should restore the reductions in the home health and hospice market basket inflation update legislated under the Balanced Budget Act of 1997 and under the fiscal year 1999 omnibus appropriations measure.
   
   
3. Overpayments. Congress should enact legislation that provides protection for home health agencies against financial ruin because of outstanding repayments resulting from the Medicare Interim Payment System (IPS). Agencies should be granted overpayment forgiveness for payments in excess of their IPS limits, provided that the care was necessary and appropriate, and that the costs are deemed reasonable by the Medicare program.
   
   

EASE REGULATORY BURDENS AND CLOSELY OVERSEE HCFA ADMINISTRATION OF THE HOME HEALTH AND HOSPICE BENEFITS.

1. OASIS data collection and reporting. Congress should provide for reimbursement of the full costs agencies incur with respect to OASIS. OASIS data collection and submission requirements should be limited to Medicare patients.
   
   
2. Administrative burdens on home health agencies. Congress should require accountability by HCFA for any changes it contemplates that would increase administrative burdens on home health agencies. Full cost benefit analyses should be conducted within the context of overall burdens already being borne by agencies. Congress should disapprove imposition of any duplicative, unnecessary, or overly burdensome requirements.
   
   
3. Oversight of administration of the home health benefit. Congress should actively oversee HCFA's administration of the home health benefit, paying particular attention to HCFA compliance with public notice and comment requirements; coordination and consistent application of policies among HCFA central, regional offices, and fiscal intermediaries; and HCFA's adherence to Congressional intent and direction when implementing changes to the home health program.
   
   

RECRUITMENT AND RETENTION OF QUALIFIED STAFF.

1. Provide sufficient payment for home and hospice care so that agencies can provide appropriate wages and benefits to clinical staff. Congress should provide that federal programs that finance home care and hospice services adjust reimbursement to allow for appropriate wage and benefit levels for all clinical staff.
   
   
2. Ensure adequate home care and hospice personnel, particularly in rural and other underserved areas. Congress should direct the General Accounting Office (GAO) and the Medicare Payment Advisory Commission (MedPAC) to conduct studies on the shortage of personnel in home care and hospice and develop recommendations on what can be done to address this growing problem. Congress should fund grants, loan-forgiveness, and other programs to create incentives for clinical staff to enter home care.
   
   

PRESERVE AND EXPAND ACCESS TO HOME AND COMMUNITY-BASED CARE.

1. Ensure coverage of acute and long-term home care and hospice. Any changes made to the health care system must: guarantee coverage of home care and hospice; include coverage of an adequate financing for long-term home care; guarantee patients freedom to choose any qualified provider; require no copayments or deductibles for home care or hospice services; apply antitrust laws to the health care system, prohibiting states and health care entities from forming anticompetitive alliances; require all health care providers to meet uniform quality standards; and preserve the Medicare and Medicaid programs.
   
   
2. Enact a comprehensive, high-quality, home- and community-based long-term care program for individuals of all ages. The federal government must take the lead in providing adequate coverage of long-term care needs for the physically disabled, chronically and terminally ill, and cognitively impaired of all ages. The foundation of this initiative should be home- and community-based care and hospice.
   
   

TABLE OF CONTENTS

1. REIMBURSEMENT FOR HOME HEALTH AND HOSPICE SERVICES
   
   
   1. Ensure Development and Implementation of an Equitable PPS With an Adequate Case Mix Adjustor
   2. Ensure Continued Care Access for High-Cost Patients And For Patients In Medically-Underserved Areas Under PPS
   3. Establish Expedited Payment Schedules for Medicare Home Health Services Under PPS
   4. Eliminate the Mandatory 15% Reduction in Home Health Reimbursement
   5. Protect Home Health Agencies from Financial Instability Resulting from Overpayments
   6. Restore the Full Market Basket Update to Home Health and Hospice Payments
   7. Oppose Proposals to "Bundle" Home Health and Hospice Benefit Payments with Payments to Other Providers
   8. Oppose Copayments for Medicare Home Health Services
   9. Oppose Cost-Sharing by Medicaid Beneficiaries
   10. Ensure Appropriate Medicaid Reimbursement of Care-Intensive Services
       
       
2. COVERAGE (INCLUDING MEDICARE REFORM)
   
   
   1. Allow Flexibility in the Delivery of Home Health Services under the Medicare Prospective Payment System
   2. Enact a Homebound Definition that Ensures Access and Eligibility for Needed Home Health Services
   3. Recognize Telehomecare as a Bona Fide Medicare Service
   4. Make All Professional Home Health Services Qualifying Services
   5. Create a Nutritional Services Home Health Benefit
   6. Create a Pharmaceutical Service Home Health Benefit
   7. Allow Payment for Home Health Services for those Receiving Adult Day Care
   8. Allow Home Care Agencies to Serve as Case Managers in Federally-Funded Programs
   9. Maintain Coverage for Individuals with Ongoing Home Care Needs
   10. Preserve the Public Nature of the Medicare Program
   11. Enact a Comprehensive, High Quality Home- and Community-Based Long-Term Care Program
   12. Ensure Coverage of Acute and Long-Term Home Care and Hospice
   13. Promote Respite Care for Family Caregivers
   14. Reinstate Venipuncture as a Skilled Service for Home Health Coverage
   15. Support Medicare Coverage of Drug Therapies in the Home
   16. Establish Minimum Federal Standards for Home Health Coverage under Medicaid
   17. Require Coverage of Home Care, Hospice and Personal Care Services in any Medicaid Reform
   18. Monitor Section 1115 Medicaid Waiver Involvement in Chronic Care
   19. Restore Personal Assistance Services as a Mandatory Medicaid Service
   20. Provide Appropriate Medicaid Reimbursement of Care-Intensive Services
   21. Reinstate Access to Medicaid in Welfare Reform
   22. Extend Spousal Impoverishment Protections to Home Care
   23. Support Tax Incentives for Family Caregivers
   24. Improve Home Care Services for Veterans
   25. Oversee the Implementation of a Comprehensive Home Care Benefit in the Military Health Services System
   26. Reauthorize and Amend the Older Americans Act
   27. Finance a Humane System of Care for Persons with AIDS
       
       
3. EASING REGULATORY BURDENS
   
   
   1. Fully Reimburse Home Health Agencies for Costs of Implementing OASIS; Limit OASIS Collection and Reporting Requirements
   2. Eliminate the Reporting of Visit Time Requirement
   3. Limit Administrative Burdens on Home Health Agencies
   4. Closely Oversee HCFA Administration of Home Health Benefit
   5. Allow Physician Assistants and Nurse Practitioners to Certify Medicare Home Health Plans of Care
   6. Ensure Reasonable Application and Implementation of Home Health Surety Bond Requirements
   7. Clarify the Definition of Branch Office
   8. Clarify Definition of Separate Entity
   9. Strengthen Requirements for Publication of Policy Changes by HCFA
   10. Provide Financial Assistance to Home Care Agencies to Implement Electronic Capabilities
   11. Provide Access to Medicare HMO Enrollment Information
   12. Provide Access to Medicaid Enrollment Information
   13. Exempt Entities that Perform Waived Tests from CLIA Certification
   14. Authorize the IRS to Issue Rulings Regarding Independent Contractor Status
       
       
4. SURVEY, MEDICAL REVIEW, AND APPEALS
   
   
   1. Coordinate Government Reviews of Home Health Agencies to Reduce Paperwork Burden
   2. Oppose User Fees for Survey and Certification Activities
   3. Establish Procedures for Provider Appeals of Survey and Certification Deficiencies
   4. Clarify Standards for the Imposition of Intermediate Sanctions on Home Health Agencies under the Medicare Act
   5. Ensure the Right of Home Health Agencies and Hospices to Select their Fiscal Intermediaries
   6. Reinstate the Presumptive Status for Home Health Waiver of Liability
   7. Prohibit Use of Sampling Audits
   8. Prohibit States from Using Costly Individual Claims Review in Third-Party Payor Recovery Efforts
   9. Limit Retroactivity of Fiscal Intermediary Determinations
   10. Permit Suits and Authorize Punitive Damages against Fiscal Intermediaries for Bad Faith Medicare Decisions
   11. Implement Informal Cost Report Reimbursement Appeals
   12. Permit Direct Provider Appeal Rights
   13. Reinforce Beneficiary Due Process Rights
   14. Enact a National Standard for Processing ALJ Appeals
   15. Preserve Independence of Administrative Law Judges
   16. Improve Access to Judicial Review for Medicare Claims
   17. Allow Expedited Judicial Review of Medicare Reimbursement Disputes
   18. Ensure and Enforce Beneficiary Choice in all Federal Health Care Programs
   19. Establish Safe Harbors and De Minimus Thresholds under the False Claims Act
   20. Oppose Efforts to Strip Bankruptcy Protections from Health Care Providers
       
       
5. PROMOTING COLLABORATION, STAFF COMPETENCY, AND CONSUMER, CAREGIVER AND PROGRAM PROTECTIONS
   
   
   1. Provide Sufficient Home Care and Hospice Payments so that Agencies Can Provide Appropriate Wages and Benefits to Clinical Staff
   2. Ensure Adequate Home Care and Hospice Personnel, Particularly in Rural and Other Underserved Areas
   3. Protect Patients and Providers with Respect to Medical Record Privacy
   4. Encourage Appropriate, Collaborative Role of Physicians in Home Care
   5. Ensure Access to Home Care and Full Federal Funding in any Proposals to Require Medical Directors in Home Health Agencies
   6. Require Medical Residents and Interns to Have Home Care and Hospice Experience as Part of Their Graduate Medical Education
   7. Coordinate Home Care Aide and Nursing Home Aide Training Requirements
   8. Strengthen the Home Health Aide Training Requirements Contained in OBRA-87 and Appropriately Reimburse Agencies for Training Costs
   9. Allow LPNs to Supervise Home Care Aides
   10. Establish Federal Medicaid Standards for Personal Care Services
   11. Require Contractors of Care in the Home to Ensure Supervision and Support of Paraprofessionals
   12. Develop Quality of Care Standards for Consumer-Directed Care
   13. Encourage States to Adopt Licensure Laws and Regulations for Home Care Agencies
   14. Prevent Violence Against Home Care Workers
   15. Require Federally Funded Criminal Background Checks and Establish a National Registry System
   16. Enact Home Care Specific Anti-Fraud Measures
   17. Enhance Consumer Protections for Home Care Recipients
   18. Eliminate Elder Abuse
       
       
6. INSURANCE REFORM HEALTH PLAN REGULATION
   
   
   1. Require Inclusion of Home Care Coverage for Early Maternity Discharge
   2. Ensure Patients' Rights in Managed Care Plans
   3. Protect Consumers from Erroneous Service and Coverage Determinations
   4. Protect Patients' Freedom to Choose
   5. Preserve Rights of Home Care Patients in Federally-Qualified HMOs
   6. Prohibit Gag Rules in Managed Care Contracts
   7. Modify Preemption Provision of the Employee Retirement Income Security Act
   8. Amend the Employee Retirement Income Security Act to Require Direct Provider Appeal Rights
   9. Authorize Punitive Damages Lawsuits for Bad Faith Insurance Decisions
   10. Establish Meaningful Standards for Private Long-Term Care Insurance
   11. Enact Insurance Market Reforms
       
       
7. HOSPICE
   
   
   1. Restore the Full Market Basket Update to Home Health and Hospice Payments
   2. Oppose Proposals to "Bundle" Home Health and Hospice Benefit Payments with Payments to Other Providers
   3. Ensure Coverage of Acute and Long-Term Home Care and Hospice
   4. Ensure the Right of Home Health Agencies and Hospices to Select their Fiscal Intermediaries
   5. Require Medical Residents and Interns to Have Home Care and Hospice Experience as Part of Their Graduate Medical Education
   6. Ensure Adequate Home Care and Hospice Personnel, Particularly in Rural and Other Underserved Areas
   7. Provide Sufficient Home Care and Hospice Payments so that Agencies can Provide Appropriate Wages and Benefits to Clinical Staff
   8. Oppose Implementation of Penalties for Erroneous Certification of Terminal Illness
   9. Clarify the Definition of Hospice Multiple Sites
   10. Protect Hospice Agencies from the Impact of Sequential Billing
   11. Ensure Access to Medications Necessary for Pain Control
   12. Amend Hospice Core Service Requirements to Permit the Delivery of Specialized Nursing Treatments Under Contract
   13. Mandate Hospice Coverage Under Medicaid
   14. Include In-Home Respite Care in the Medicare Hospice Benefit
   15. Eliminate Medicare Provision Requiring Hospice Social Worker to Practice Under the Direction of a Physician
   16. Oppose Decreasing Hospice Reimbursement for Dually-Eligible Patients Residing in Nursing Facilities
   17. Ensure the Portability of Advance Directives
   18. Require Demonstration Projects to Study Special Services and Financing of End-of-Life Care
   19. Ensure the Provision of Medicare Coverage of Pain Medications
       
       
8. PEDIATRICS
   
   
   1. Monitor States' Compliance with IDEA Obligations
   2. Allow Payment for Home Health Services for Center-Based Care for Technology-Dependent Children
   3. Improve Reimbursement Requirements for Pediatric Home Care under Medicaid
   4. Require Demonstration Projects to Study Special Services and Financing of End-of-Life Care for Pediatric Patients
   5. Provide Access to Home Care Services for Pediatric Patients with More Intensive Care Needs
   6. Preserve Rights of Pediatric Home Care Patients in Federally Qualified HMOs
   7. Enact a Homebound Definition that Ensures Access and Eligibility for Needed Home Care Services for Pediatric Patients
      
      
9. HOME MEDICAL EQUIPMENT
   
   
   1. Allow Physician Assistants and Nurse Practitioners to Certify Medicare Home Medical Equipment Plans of Care
   2. Ensure HME Supplier Representation on MedPAC
   3. Protect Home Oxygen Services Medicare Reimbursement
   4. Encourage States to Adopt a Licensure Law and Regulations for Home Medical Equipment (HME) Providers
   5. Incorporate HME Community Input in HCFA's Inherent Reasonableness Authority
   6. Repeal Home Medical Equipment Competitive Bidding Demonstration Projects
   7. Ensure Adequate Reimbursement for Home Medical Equipment, Parenteral and Enteral Nutrition, and Oxygen Supplies
   8. Repeal Consolidated Billing by Skilled Nursing Facilities
   9. Ensure Reasonable Application and Implementation of Home Medical Equipment Surety Bond Requirements
      
      
10. HOME CARE AIDE
    
    
    1. Oppose Cost-Sharing by Medicaid Beneficiaries
    2. Allow Home Care Agencies to Serve as Case Managers in Federally-Funded Programs
    3. Maintain Coverage for Individuals with Ongoing Home Care Needs
    4. Enact a Comprehensive, High Quality Home- and Community-Based Long-Term Care Program
    5. Ensure Coverage of Acute and Long-Term Home Care and Hospice
    6. Promote Respite Care for Family Caregivers
    7. Establish Minimum Federal Standards for Home Health Coverage Under Medicaid
    8. Require Coverage of Home Care, Hospice and Personal Care Services in Any Medicaid Reform
    9. Monitor Section 1115 Medicaid Waiver Involvement in Chronic Care
    10. Restore Personal Assistance Services as a Mandatory Medicaid Service
    11. Provide Appropriate Medicaid Reimbursement of Care-Intensive Services
    12. Reinstate Access to Medicaid in Welfare Reform
    13. Extend Spousal Impoverishment Protections to Home Care
    14. Support Tax Incentives for Family Caregivers
    15. Improve Home Care Services for Veterans
    16. Oversee the Implementation of a Comprehensive Home Care Benefit in the Military Health Services System
    17. Reauthorize and Amend the Older Americans Act
    18. Provide Access to Medicaid Enrollment Information
    19. Authorize the IRS to Issue Rulings Regarding Independent Contractor Status
    20. Provide Sufficient Home Care and Hospice Payments so that Agencies can Provide Appropriate Wages and Benefits to Clinical Staff
    21. Ensure Adequate Home Care and Hospice Personnel, Particularly in Rural and Other Underserved
    22. Protect Patients and Providers with Respect to Medical Record Privacy
    23. Coordinate Home Care Aide and Nursing Home Aide Training Requirements
    24. Strengthen the Home Health Aide Training Requirements Contained in OBRA-87 and Appropriately Reimburse Agencies for Training Costs
    25. Allow LPNs to Supervise Home Care Aides
    26. Establish Federal Medicaid Standards for Personal Care Services
    27. Require Contractors of Care in the Home to Ensure Supervision and Support of Paraprofessionals
    28. Develop Quality of Care Standards for Consumer-Directed Care
    29. Prevent Violence Against Home Care Workers
    30. Require Federally Funded Criminal Background Checks and Establish a National Registry System
    31. Enhance Consumer Protections for Home Care Recipients
    32. Eliminate Elder Abuse
    33. Modify Preemption Provision of the Employee Retirement Income Security Act
    34. Amend the Employee Retirement Income Security Act to Require Direct Provider Appeal Rights
    35. Authorize Punitive Damages Lawsuits for Bad Faith Insurance Decisions
    36. Establish Meaningful Standards for Private Long-Term Care Insurance
    37. Enact Insurance Market Reforms
        
        
11. FACT SHEETS ON HOME CARE
    
    
    1. What is Home Care?
    2. Who Provides Home Care?
    3. How is Home Care Paid For?
    4. Home Health Legislation 1980-1999

Return to the HOMECARE Online Center!

We love receiving comments and suggestions for improvement!
Send them to webmaster@nahc.org