As old 1999 left, the 2000 millennium baby brought home care much-needed relief from the Balanced Budget Act (BBA) as well as an introduction to the Prospective Payment System (PPS). In this issue of HHN, you will find an excellent article on PPS and how it will affect your agency and your practice as well as a copy of the editor's thoughts on issues to consider regarding the proposed regulations. I encourage you to read and share this information with others!
This legislative update outlines an overview of HR 3194, the Omnibus Consolidated Appropriations Act of 2000. Following approval by the House of Representatives and the Senate, this bill was signed into law by President Clinton on November 29, 1999; it provides relief from the BBA for home health agencies (HHA), hospices, and durable medial equipment (DME) companies.
The legislative provisions of HR 3194 include:
* A delay of the home health 15% reimbursement reduction scheduled for October 2000. This reduction will be delayed at least 1 year after PPS implementation and could be eliminated altogether.
* Reimbursement assistance for mandated reporting requirements. This provision provides $10 per beneficiary per year for the collection of OASIS data.
* A 2% increase of the per beneficiary limit for those home health agencies currently under the national median, retroactive from October 1999.
* Relief from the initial stringent requirements for home health agencies in obtaining surety bonds. HHAs will be required to obtain a bond by October 2000, but it will only be required for 4 years versus the entire time of program participation. These surety bonds would be limited to the lower of $50,000 or 10% of program revenues and would not require separate bonds for Medicare and Medicaid.
* DME billing will not be included in home health agency consolidate billing, a major victory for both HHAs and DME providers.
* DME providers also received relief from HCFA's "inherent reasonableness" authority. This pricing activity will be suspended until further investigation by the General Accounting Office is completed. This activity has had a devastating financial impact on many medical equipment providers and has allowed for inconsistencies in reimbursement practices across various HCFA regions.
* Hospice providers will soon see increased reimbursement: 0.5% in fiscal 2001 and 0.75% in fiscal 2002.
This act also included several studies to review the impact and reasonableness of the BBA as well as other regulatory activities. Some of the studies include:
* Congressional review of the 15% cut to home health agency reimbursement.
* A study on OASIS cost and impact on patient privacy.
* A MedPac study on possibly eliminating rural HHA providers from PPS.
* GAO study on "inherent reasonableness" impact on medical equipment providers.
The success of this bill only occurred by the work of many organizations and individuals. Although there is often a discrepancy between agencies on how to get goals accomplished, this legislation validates the joining of forces to support a common good - health care at home.
A special note of thanks to those organizations and individuals that refused to give up until relief was found. Be sure to thank these groups as well as President Clinton and your legislative leaders who signed this bill. An extra special thanks goes to each nurse or home care provider or supporter who called or wrote Congress to tell of the difference home care makes in people's lives. Congratulations!