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Washington, D.C. -- Wyoming home health care patients and providers would be spared scheduled Medicare funding cutbacks and inefficient regulation changes if new legislation being cosponsored by U.S. Senator Mike Enzi, R-Wyo., is passed.

Enzi said the Medicare Home Health Equity Act, S. 1310, introduced this week by fellow Senate Health, Education, Labor and Pensions Committee member Susan Collins, R-Maine, would adjust reforms made in the 1997 Balanced Budget Act that restrict Medicare patient access to home health care.

"People want to retain their independence and avoid going to the hospital or nursing home where care is less convenient and costlier. The present system makes it harder for people to stay at home, but this new bill would fix the present system to accommodate especially those most in need, the patients with serious ailments requiring multiple visits," Enzi said. "There are 50 plus licensed home health care providers that serve more than a thousand patients just in Wyoming. There are 3 million Medicare beneficiaries who receive Home Health services."

Enzi said home health care providers are now paid by Medicare under an "interim payment system" until a permanent system is developed. Under the current system nearly 40 percent of home health providers surveyed indicated there were patients whom they previously would have accepted whom they no longer accept due to the current payment system, according to a survey conducted by the Medicare Payment Advisory Commission. Thirty-one percent said they had discharged patients due to the system.

The Medicare Home Health Equity Act would eliminate the automatic 15 percent reduction in Medicare home health payments scheduled for Oct. 1, 2000.

When the 15 percent reduction in Medicare home health payments was decided, the Congressional Budget Office (CBO) reported the effect of the decision would be to reduce home health expenditures by $16.1 billion between fiscal years 1998 and 2002. In March the CBO revised its figures and now the reductions are expected to exceed $47 billion. Enzi said it is unnecessary for the 15 percent reduction because the budget target for home health outlays will be achieved, if not exceeded without the cut.

The bill would eliminate the 15-minute incremental reporting period required by the Balanced Budget Act. The legislation would direct the Health Care Financing Administration to develop a more reasonable method of figuring the time spent with patients, one that takes into account the time it takes providers to travel to patients homes and time spent consulting with the patients physicians. The Balanced Budget Act requires home health providers to record the length of time of home health visits in 15-minute increments starting Thursday, July 1, 1999. Enzi said this requirement is excessively labor intensive, difficult for staff and disrupts patient care.

The proposal would also increase the per-beneficiary cost limit for providers with limits below the national average to the national average cost per patient over a three-year period. The Balanced Budget Act of 1997 system bases a provider's average per-patient reimbursement on that provider's average cost per patient in 1993 or 1994. As a consequence, the system unfairly penalizes historically cost-efficient home health agencies that have been most prudent with their Medicare resources.

The bill would also:

  • Provide supplemental "outlier" payments to home health providers on a patient-by-patient basis, if the cost of care for an individual is considered by the Secretary of Health and Human Services to be significantly higher than average due to the patient's particular health and functional condition;
  • Revises the surety bond requirement for home health providers to more appropriately target fraud;
  • Increases the current payment system per-visit cost limit from 105 percent to 108 percent of the national median and;
  • Extends the current system overpayment recoupment period to three years without interest.