NAHC Meets with CBO on Care Planning Improvement Act
September 1, 2015 08:09 AM
The National Association for Home Care & Hospice (NAHC) met with officials from the Congressional Budget Office (CBO) to discuss the potential cost and savings implications of the Home Health Care Planning Improvement Act of 2015 (HR 1342/S578). That bill would permit non-physician practitioners (NPP) including Nurse Practitioners, Physician Assistants, Clinical Nurse Specialists, and Nurse Midwives to certify Medicare home health services comparable to physicians. This change has been a high priority for the home care community as more and more patients have NPPs as their primary care source.
The meeting was arranged by Congressman Greg Walden, the original sponsor of the bill in the House of Representatives. On the surface, such a meeting may seem a small matter. However, the progress of federal legislation is often hindered and, on occasion, blocked because CBO “scores” a bill as having a cost that is not offset by other savings or revenue. In many situations, legislation is blocked simply because CBO has not scored the bill due to other priorities. HR 1342/S578 is one such bill as a number of congressional offices and committees have pushed to have it scored to no avail in past years. The fact that the bill is now under review at CBO is positive progress for sure.
The CBO officials showed great interest in learning everything they could about what the bill does and what potential changes in care patterns and Medicare spending might be triggered by the legislation if it were enacted. NAHC, along with representatives from Congressman Walden, the House Energy and Commerce Committee, and associations representing Nurse Practitioners thoroughly explained the role played by NPPS in home care with a special emphasis on how the bill would remove an impediment to direct clinical integration and communications between home health care and the patient’s primary medical practitioner.
In addition, it was explained that Medicare could achieve savings through the legislation as it would shift physician billings to NPP billings that are reimbursed at 85% of the physician payment rates for such items as certification, recertification, and care plan oversight. At the same time, participants in the meeting conveyed that home health utilization would be made more efficient through the legislative changes rather than triggering increased utilization as NPPS currently secure physicians to certify care for their patient. It is very important that CBO see the bill as providing authorization for NPPs to substitute for physicians since adding to utilization means CBO would score the bill as having an increased cost to Medicare.
When and how CBO will actually score the bill is unknown. Meeting participants were encouraged by the open-mindedness and the serious level of the curiosity of CBO officials in getting a greater understanding of home health care and the role of NPPs. It is hoped that it can be reviewed in time for the legislation to have a chance to be included in an upcoming Medicare bill on “noncontroversial” changes.
NAHC encourages everyone to connect with their congressional delegation with a request that they all cosponsor the pending bills in the House and Senate. At this point, there is strong bipartisan support in both chambers, but we want to get that at a level that guarantees the bills will be passed this year. The easiest route to those communications is through the NAHC Legislative Action Center. See “Support the Home Health Care Planning Improvement Act of2015.” For more detailed information about the legislation such as the talking points on the bills, click here.