2000 Home Care Scorecard


NAHC AND HOME CARE COMMUNITY WIN MAJOR VICTORIES

Since enactment of the Balanced Budget Act of 1997 (BBA), the National Association for Home Care (NAHC), its state association affiliates, and its members have actively pursued legislative relief. During 1998, the Congress made a "down payment" on BBA reform efforts by delaying the 15 percent cut originally scheduled for October 1, 1999, and providing modest increases for agencies with low payment limits.

During 1999, NAHC and its affiliates led a united home care industry toward winning relief from a number of crucial problems as outlined below. NAHC and the home care community, together, were successful in winning total or significant relief from each of the top six objectives as determined by a January 1999 poll of the membership. Details follow.

PROBLEM NAHC/INDUSTRY GOAL FINAL RESULTS
  • An additional 15% cut in Medicare payments scheduled to take effect 10/1/2000.
    		• Eliminate the cut or, at a minimum, delay it. Congress delayed the 15% cut until 1 year following the implementation of prospective payment (PPS) and mandated a study on whether to make the cut permanent.
  • IPS related "overpayment" threatened the viability of many agencies.
    		• Obtain relief from "overpayments", including forgiveness of interest. HCFA agreed to automatic 3 year repayment plans, 1 year of which is interest free. Congress asks HCFA to provide 3 years interest forgiveness.
  • IPS payment limits were set too low for many providers.
    		• Obtain increase in the per visit and per beneficiary limits. Congress increased the per beneficiary limit for agencies below the national median by 2%.
  • Agencies are required to prorate (share) their IPS limits if another agency has served the same patient.
    		• Eliminate proration requirement or restrict it to situations where agencies purposefully try to evade Medicare limits. HCFA agrees to drop proration in current form; they claim a simplified version will be inherent in PPS reimbursement
  • Home health agencies would be required to bill for Durable Medical Equipment (DME) under PPS, 10/1/2000.
    		• Eliminate the requirement. Congress deleted this requirement.
  • Surety bonds were required of all agencies participating in Medicare and Medicaid; a separate bond was required for Medicare and Medicaid, each of which was a greater of $50,000 or 15% of total agency revenue. This requirement was perpetual.
    		• Limit bonds to a maximum of $50,000; require only 1 bond for both Medicare/Medicaid, and eliminate the requirement for agencies with a "good record". Congress limited surety bonds to the lesser of 10% of Medicare/Medicaid income or $50,000; single bond is accepted for both programs; the requirement will not begin until PPS becomes effective and agencies will only have to carry the bond for 4 years.
  • Agencies are required to collect data from patients using a form called OASIS and were not reimbursed for doing so.
    		• Ensure that agencies are reimbursed for their costs and that the form is limited in its application to Medicare/Medicaid skilled nursing patients and does not apply to private pay clients. Congress authorized $10 per beneficiary payment in FY2000; required a study to determine if OASIS inappropriately intrudes on patient privacy.

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