The 2002 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, state association representatives, and a survey of the NAHC members. It has been 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. NAHC 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 trade 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.
Since passage of the Balanced Budget Act of 1997 (BBA), the Medicare home health benefit has been seriously eroded. Access to care has become a major problem, particularly for patients with care-intensive needs. Centers for Medicare and Medicaid Services (CMS) data indicate that between calendar years 1997 and 1999, there was a 24 percent drop in number of patients served, a 56 percent reduction in total visits, a 53 percent decrease in payments, a 38 percent drop in the average payment per patient, a 42 percent decrease in the average number of visits per patient, and 48 percent fewer claims processed. Since October 1997, 3,300 fewer agencies are available to serve Medicare beneficiaries nationwide, which represents a 1/3 reduction in the total number of agencies. These reductions have been evidenced in every state in the nation.
On October 1, 2000, CMS instituted a new, episode-based prospective payment system (PPS) for home health payments. This payment system has the potential to help stabilize the program and more adequately provide needed services to Medicare beneficiaries than its predecessor, the interim payment system (IPS), did. However, the PPS will fall short of this goal if not properly crafted and implemented, as well as adequately funded.
Home care agencies throughout the country are reeling from the financial constraints imposed by the BBA and the administrative adjustments required for adaptation to the PPS. At the same time agencies are experiencing record difficulty in recruiting and retaining staff needed to adequately serve the growing population of disabled and elderly patients. Financially strapped home health agencies are hard-pressed to compete with other employers that offer better wages, better benefits, lighter workloads, and better hours.
These are the challenges facing home care as it enters the 21st century, and the context within which the National Association for Home Care (NAHC) has chosen the following issues as the focus of its legislative advocacy efforts during the year 2001. Central to NAHC’s mission is to preserve the integrity of and access to 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.
Congress should:
Congress should safeguard the viability of the home health PPS by:
Congress should, to the extent practicable, ease regulatory burdens and provide greater flexibility to allow for maximum effectiveness and efficiencies in the delivery of care by:
- Closely overseeing CMS administration of the home health and hospice benefits;
- Limiting administrative burdens on home health agencies and on hospices;
- Authorizing home health agencies to utilize PPS payments in a flexible manner (such as for use of nutritionists, respiratory therapists, telehomecare or other new technologies) in order to achieve quality of care and efficiencies without adverse consequences relative to payment, coverage, and compliance with the conditions of participation;
- Fully reimbursing home health agencies for costs of implementing OASIS and limiting OASIS data collection and reporting requirements;
- Allowing physicians assistants and nurse practitioners to certify Medicare home health plans of care; and
- Enacting a homebound definition that ensures access and eligibility for needed home health services.
Congress should encourage the availability of an adequate cadre of home care and hospice personnel, particularly in rural and other underserved areas, by:
- Providing sufficient home care and hospice payments in federal programs so that agencies can provide appropriate wages and benefits to clinical staff; and
- Supporting health reform proposals that provide affordable health insurance to uninsured, low-wage workers.
As part of any efforts to reform or expand federal health care programs, Congress should:
- Oppose copayments for Medicare and Medicaid home health and hospice and proposals to bundle home health and hospice payments in with payments to other providers;
- Ensure coverage of acute and long-term home care and hospice;
- Explore alternative methods of providing care for children and adults in the final phases of life by requiring demonstration projects to study special services and financing of end-of-life care for children and adults in home care and hospice settings; and
- Enact a comprehensive, high-quality, home and community-based long-term care program for individuals of all ages.
About the Blueprint
NAHC Key Legislative Issues