Home Care Cuts Working Their Way Through Congress

If Congress goes ahead with its health care reform package, home care providers will certainly feel the heat. After the House and Senate passed their respective reform bills, Congress' ability to send one approved reform bill to the US president is looking positive.

In order to get the legislation to the president's desk by his State of the Union soon, Democratic lawmakers are talking about unconventional ways of getting the bill passed.

While both bills contain tens of billions of dollars in cuts to home health agency and Medicare rates, observers say that the Senate bill is friendlier to the industry. This time there are no reimbursement changes for 2010 and 1 percent reductions in the inflation update in 2011-2013.

One of the routes to approval that lawmakers are thinking about is having the House pass a bill with the changes made in the Senate version. This is owing to the fact that the Senate had a much narrower margin of victory for its legislation. After that, the Senate would approve the House-passed version and it could go to the president.

This could auger well for home care since the Senate's cuts are slightly less drastic as compared to those in the House bill. But both the ways will spell payment reductions for providers.

More trouble: The Senate bill contains a separate provision that could auger bad news for home care providers.

The Senate bill, besides out-and-out payment cuts, calls for an advisory body similar to the Medicare Payment Advisory Commission to set payment levels for Medicare providers.

The Independent Payment Advisory Board (IPAB) would be presidentially appointed. NAHC protests that the bill would give IPAB too much power to the Executive branch. Moreover, IPAB would not have broad-based experience provided that it would comprise only 15 members appointed by the president.

Moreover, unpredictability would reign from year to year as IPAB could change rules with little input from Congress or the public. In the meantime, as the health reform package does not presently address durable medical equipment suppliers' main concerns this year - competitive bidding and oxygen caps - suppliers are rallying support for another bill, H.R 3790.

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