President's 2006 Medicare Budget Appears to Spare New Cuts to Homecare, USA

Main Category: Caregivers / Homecare
Article Date: 11 Feb 2005 - 0:00 PDT


The USA President's 2006 budget, released Monday, appears not to include any new homecare cuts in Medicare. Summaries circulated by the administration stressed continuing implementation of the new prescription drug benefit and collaboration with stakeholders on pay-for-performance (P4P) initiatives as key priorities. The materials also mentioned efforts required by the Medicare Modernization Act (MMA) to prevent unnecessary costs through preventive benefits, use of average sales price (ASP) for drugs, and competitive bidding for home medical equipment.

Missouri Legislators Hear Compelling Medicaid Testimony from Homecare Provider

On Monday, homecare provider Brady Vestal put proposed Medicaid cuts in Missouri in stark perspective for a House appropriations committee there. Vestal is Director of Home Medical Equipment for Citizens Memorial Healthcare in Bolivar, MO, and also represents the Midwest Association for Medical Equipment Suppliers as a state chair. His testimony is excerpted below.

"Under the proposed budget, in 2006 home oxygen equipment would no longer be available to Missouri Medicaid patients. For you and me with normal blood oxygen levels, this fact has no direct impact. Oxygen equipment to a patient with Chronic Obstructive Pulmonary Disease, however, is life-sustaining equipment. Let me repeat that statement - home oxygen equipment is life-sustaining equipment for patients with compromised respiratory conditions."

"What's more, home oxygen equipment can be provided at a fraction of the cost than a nursing home stay. For example, Missouri Medicaid currently reimburses home oxygen providers $199.50 a month for a home oxygen concentrator-a machine the size of a small suitcase that pulls in room air, filters out the nitrogen, and delivers pure oxygen through a nasal cannula. Again, without this oxygen concentrator the typical COPD patient would reside in a nursing home where the average cost to provide care is about $3,000 per month. And how would the nursing home deliver the life sustaining oxygen to this patient? It would use the exact same concentrator since it is the most efficient and cost-effective method for the delivery of supplemental oxygen."

"Just as immunizations ward off preventable diseases and the costs associated with their care, durable medical equipment also saves Medicaid money by preventing serious injuries. Equipment such as wheelchairs, walkers, and hospital beds provide elderly patients with the assistance they need to live normal lives in a safe and healthy manner."

"I must ask the question: How much money does the Medicaid program save by purchasing a patient a walker for $114 if that walker prevents one fall and one broken hip and all the care to repair and rehabilitate that patient back to normal health? Best estimates are in the tens of thousands of dollars for just that one patient."

CONTACT: Brady Vestal, Director, Citizens Memorial Home Medical Equipment, 1915 S Springfield, Bolivar, MO 65613 (417) 326-8736.

A New System of Medicare Contractors Begins Phase-In this Year

Starting in December, a new system for Medicare contractors will begin to replace the DMERC structure. It will include four administrative contractors to handle home medical equipment (HME) claims and four to handle home health claims. The system will allow providers to participate in annual evaluations of the contractors, who will have performance-based incentives.

A February 7 report to Congress, "Medicare Contracting Reform: A Blueprint for a Better Medicare," describes changes, which are mandated by MMA and are designed to reduce costs. The idea is to open the range of financial entities that will be permitted to serve as Medicare Administrative Contractors, to be determined by competitive bidding.

The Centers for Medicare and Medicaid Services (CMS) said it will replace fiscal intermediaries and carriers that currently process claims from hospitals, physicians and suppliers of services with 15 administrative contractors responsible for processing both Part A and Part B claims and the additional 8 administrative contractors to process home health and HME claims. The new contractors will focus on customer service, operational excellence, and financial management. CMS will contract separately for specialized tasks such as program safeguard activities, coordination of benefits, and a new appeals function, to be handled by qualified independent contractors.

To view the Report to Congress, see: cms.hhs.gov/medicarereform/contractingreform

S. 300, Rural Home Health Add-On Bill Is Introduced in Senate by Collins

Senator Susan Collins (R-ME) has introduced a bill to extend for two years (to April 1, 2007) the rural add-on payment for home health services. This is the companion bill to H.R. 11, which now has 30 cosponsors. Also signing on with Collins as cosponsors are Senators Feingold, Lugar, Landrieu, Burns, Murkowski, Bond, Thomas, Cochran, Santorum, Lincoln, Jeffords, Conrad, and Leahy.

Please ask your Members of Congress to sign on to the House and Senate bills. Unless Congress takes action, the rural add-on expires in April. See http://www.aahomecare.org.

Criminal Background Checks Begin in 7 States

CMS is moving forward with the criminal background pilot mandated by the Medicare Modernization Act in seven states, Alaska, Idaho, Michigan, Nevada, New Mexico, and Wisconsin. The pilot will run from January 1, 2005, to September 30, 2007. The purpose of the demonstration is to identify effective, efficient, and economical criminal background check practices for providers of long-term-care services, including home health and nursing homes.

States have the option to include hospice, assisted living facilities, and home and community based waiver providers, among other settings. Participating states will have different payment mechanisms to cover program costs and a variety of penalties for providers who are not compliant. Prior to a worker's employment, the provider must conduct a ten-roll fingerprint and a search of all state and national criminal records, as well as other available databases and registries. The states can allow provisional employment with supervision during the background investigation process, with each state defining what constitutes appropriate supervision.

Medtrade and Washington Leadership Conferences Near

Mark your calendars for Medtrade Spring, April 5-7 in Las Vegas, including AAHomecare's Continuum of Care on April 5, and don't forget AAHomecare's Washington Leadership Conference, June 7-10 at the J.W. Marriott, Washington, DC.

American Association for Homecare, 625 Slaters Lane, Suite 200, Alexandria, VA 22314. For more information, please call AAHomecare at (703) 836-6263. http://www.aahomecare.org.

Michael Reinemer
Vice President, Communications
American Association for Homecare
625 Slaters Lane, Suite 200
Alexandria, VA 22314-1171
703-535-1881
http://www.aahomecare.org

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