Legislative Priorities and Positions

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:
   
   
   1. 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.
      
      
   2. 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.
      
      
   3. 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.
      
      
   4. 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.
   
   

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