Familiar battles abound in 2005

Friday, December 31, 2004

Sometimes working on the legislative and regulatory issues for homecare issues feels like that movie “Groundhog Day.” The movie is about a tortured soul who wakes up morning after morning only to find that he is stuck living the exact same day over and over again.

But it’s only a fleeting feeling. The reality is that the homecare industry has the potential to shape its own destiny in Washington. Every new day brings a fresh opportunity to strengthen homecare.

Our challenge in 2005 will be to continue to bring new, fresh efforts to many of the same issues we worked on last year such as the cuts in home medical equipment reimbursement, tying them to Federal Employees Health Benefits Plan levels.

The good news is that many of the players in Congress and at the CMS remain at their posts in Washington. We have made excellent strides during the past year bringing them up to speed about homecare issues. The bad news is Medicare will be a large, tempting target for spending cuts. However, the homecare industry has a good argument that it must make for strengthening homecare in order to deliver value for Americans’ healthcare dollar.

Here’s a look at some key issues.

Average sales price

Last year, we succeeded in getting a large increase in the dispensing fee for inhalation drug therapies in 2005 to offset the change in reimbursement to the average sales price formula. But CMS will probably revisit this issue for its 2006 fee schedule and therefore the homecare industry must follow the issue closely again this year. We will need to gather and present good data to CMS to support our case for an adequate dispensing fee to preserve patient access to home inhalation therapy.

FEHBP cuts

The cuts in home medical equipment items required by the Medicare Modernization Act of 2003 (MMA) remains an issue because the patient population served by the Federal Employees Health Benefits Program (FEHBP) is younger and healthier than the Medicare population. The Hobson-Ford bill, H.R. 4491, to repeal the cuts accumulated 118 cosponsors in a mere six months. That is great progress for a bill in a legislative environment where healthcare was on the congressional agenda. AAHomecare and its members will continue efforts to repeal these cuts during the 109th Congress in both the House and Senate.

Competitive Bidding

During 2005, the homecare industry will continue to work through the CMS Program Advisory and Oversight Committee (PAOC) on competitive bidding to ensure that it does not hurt access to homecare. AAHomecare’s representative as well as others on the PAOC are working to ensure that quality standards are adopted and in place before competitive bidding goes into effect and that clinical factors are carefully considered to determine whether a given item is suitable for competitive bidding.

Power Wheelchair Codes

The industry will have a new set of power wheelchair codes. AAHomecare’s Rehab and Assistive Technology Council (RATC) will continue to work with CMS and the DMERC medical directors on a range of wheelchair and mobility issues to ensure that patients, including those with limited ambulation, continue to have access to mobility.

COPD Caucus

The Congressional COPD Caucus will continue to be an important focus for homecare for several reasons. In many ways, COPD patients reflect the human face of the homecare community. These patients often require home health services, home oxygen and inhalation drug therapy, rehab and mobility during the course of this chronic disease. AAHomecare will continue to work with the Caucus to raise awareness about the overall patient benefits associated with homecare as well as the cost-savings for Medicare.

The 109th Congress will provide many opportunities to make a strong case that homecare is more valuable than ever before. It’s the solution to America’s health care crisis.

Kay Cox is president and CEO of the American Association for Homecare.