Action Alert: Urge Congress to Amend SGR Legislation to Remove Surety Bond Requirement and Repeal or Revise Face-to-Face Physician Documentation Rule
April 7, 2015 10:52 AM
Now is an important time for home care and hospice advocates to urge their members of Congress to amend the Sustainable Growth Rate (SGR) replacement legislation. Congress should remove the SGR bill’s current surety bond requirement on home health agencies and add language repealing or revising the face-to-face physician documentation rule.
As NAHC previously reported, Members of Congress adjourned for their two-week April recess without the Senate having passed legislation to permanently replace the SGR. Senate leaders plan to consider the SGR legislation after returning on April 13. The Centers for Medicare & Medicaid Services (CMS) has stated that it can hold off on processing claims until April 15, which provides Congress with two days to pass a final bill before physicians start to experience payments reductions.
While it may be unlikely that Congress will either open the bill for amendments or accept more than a small number of amendments agreed upon in advance, we want to make another effort to stop the surety bond and obtain F2F relief in the SGR legislation. At a minimum, the effort will help set the stage for further advocacy as Congressional leaders have indicated they expect more Medicare legislation later this year.
Here are the issues NAHC encourages advocates to emphasize with their members of Congress.
Remove the Surety Bond Requirement on Home Health Agencies
The current SGR bill contains a modification of the home health surety bond requirements, setting the bond minimum at $50,000 and allowing Medicare to scale the bond value up commensurate with the volume of Medicare revenue in the home health agency.
Currently, Medicare has the authority to impose a surety bond on home health agencies but has chosen against doing so. The provision in the SGR bill would make the surety bond a mandatory condition for all home health agencies to participate in Medicare. It would also require that a bond be no less than $50,000 in value with the authority to scale the bond amount to much higher levels based upon the Medicare revenue in the home health agency.
According to information NAHC obtained from the Congressional Budget Office, the bond requirement would bring only $10 million in Medicare savings over 10 years, while NAHC estimates the cost of the bonds to be $130 million over that same period of time. The small savings is indicative of the fact that virtually all Medicare overpayments are fully repaid by home health agencies. While achieving minimal savings, the nonsensical surety bond requirement could drastically harm agencies and limit access to care.
Please urge Congress to amend the SGR legislation to remove the surety bond requirement on home health by clicking here.
Repeal or Revise Face-to-Face Physician Documentation Requirement
Currently, the SGR bill does not include relief from the burdensome face-to-face physician encounter requirements.
As NAHC has reported extensively, a provision of the Patient Protection and Affordable Care Act requires a patient to have a face-to-face encounter (F2F) with a physician to certify the need for Medicare home health services. CMS’s flawed rule implementing the ACA provision includes burdensome paperwork requirements that have caused confusion among physicians, home health agencies, and other parties involved.
As a result, the rule has limited access to care and posed a high risk that Medicare patients who are homebound and in need of skilled care will be denied Medicare coverage. While CMS has tried to resolve these problems, the underlying regulatory requirements remain difficult to understand and apply. Congress should act to repeal or revise the documentation requirement as part of the SGR legislation.
The revisions NAHC is seeking: 1) limit the physician documentation requirement to demonstrating that a timely encounter occurred, consistent with the original intent; 2) narrow the circumstances where a F2F is required by excluding patients transferred from a hospital or SNF where physician encounters are virtually guaranteed; 3) provide an exception in areas where physicians are scarce; 4) permit a waiver in a case-specific situation where a F2F is not feasible; and 5) permit F2F encounters by way of an expanded telehealth definition as the standard in the current law is useless as the patient must leave her home to have a telehealth visit with a physician.
Urge your member of Congress to repeal or revise the F2F documentation requirement on physicians by clicking here.
Invite Your Member of Congress to Attend a Home Visit
NAHC encourages you to ask your members of Congress to accompany your agency on a home visit. This is a compelling way to inform Congress about the importance of home care and hospice for the ill, aged, and disabled. A prominent example of how effective these visits can be, Senator Susan Collins (R-ME), chair of the Senate Aging Committee, has said that accompanying a home care visit was a transformative experience and made her a passionate advocate for home care and hospice.
NAHC will continue to provide updates on the SGR legislation, as well as these key policy priorities. Please stay tuned for future action alerts.