The home care industry fought a valiant battle to defeat the Deficit Reduction Act (DRA) of 2006 (S 1932), which the President signed into law on February 8. In fact, a shift of a single vote in either the House or the Senate would have spelled defeat for the legislation.

Three DRA provisions galvanized the home care community: 1) requiring Medicare beneficiaries to assume ownership and responsibility for their medical oxygen systems after 36 months of rental; 2) ending beneficiaries’ option to continue to rent certain HME items after 13 months; and 3) eliminating the 2.8% home health market update for 2006.

The industry will fight similar battles throughout 2006 as Congress grapples with the Fiscal Year 2007 budget and works toward passage of another DRA. President Bush’s fiscal year (FY) 2007 budget includes several additional cuts to Medicare home care benefits such as: a proposal to force an ownership transfer of medical oxygen equipment to Medicare beneficiaries after 13 months, rather than 36 months as stipulated by the DRA; elimination of beneficiaries’ ability to purchase power wheelchairs in the first month; and a freeze on home health reimbursement for 2007.

The proposed limit of 13 months on oxygen rentals would exacerbate the 36-month cap that was included in the DRA. Forced transfer of ownership of oxygen equipment places unfair burdens on beneficiaries and their family members.

With regard to the purchase of power wheelchairs, these wheelchairs are typically provided to beneficiaries with long-term disabilities. Currently, more than 95% are purchased in the first month.

The freeze on home health reimbursement is unwarranted and unwise, given rising costs of gasoline; the need for home health agencies (HHAs) to be competitive to recruit and retain nurses and therapists; the impetus to integrate health information technology and telehealth into home health agency operations; and the loss of significant reimbursement on January 1 for many HHAs as a result of CMS’ adoption of Core Based Statistical Areas for the wage portion of home health PPS reimbursement.

Prospects for Another DRA
It will be up to Congress to decide whether to pass legislation containing Medicare recommendations from the President’s FY 07 budget proposal. Because this is an election year, additional Medicare cuts may be difficult to pass, but that does not mean that they are not a distinct threat.

Bear in mind that physicians’ Sustainable Growth Rate problem will be right back on Congress’ plate next January 1, with a price tag of more than $10 billion to prevent a significant reimbursement reduction. Congress will be on the spot to address this dilemma once again, and will look around for low hanging fruit as “pay for’s” to make physicians whole.

Although it is likely that Congress will delay votes on painful Medicare and Medicaid reductions until after November elections, the industry is on notice that there is a battle ahead. But many members of Congress are also on notice from their own constituents who oppose further reductions to home care services.

Although some Congressional offices indicated impatience with beneficiaries who contacted them with concerns about taking ownership of their home oxygen equipment, vocal communications from consumers and their family members should make these members more reticent about cutting these vital services again this year.

We cannot afford to lose momentum in the weeks and months ahead. Now is the time to enter into an ongoing dialogue with US Senators and Representatives, physicians, consumers, and the media.

Hobson-Tanner HR 3559
AAHomecare is working with state associations to advocate for passage of the Hobson-Tanner bill, HR 3559, which would help to preserve competition and protect the small business infrastructure to ensure quality and access to HME.

As of this writing, there are 74 House members who have signed on as cosponsors. The bill has excellent bipartisan support, including some members of the GOP leadership, and the two key committees—Ways and Means and Energy and Commerce.

Eleven Steps for 2006
To prevent a repeat of the just-completed FY 2006 Deficit Reduction Act scenario, home care providers should spend the next 2 to 3 months forging alliances with partners in the community such as senior citizen groups and disease-specific associations; developing grassroots strategies; engaging the media in the community; getting involved in the political process; and building strong relationships with members of Congress at the local level. Providers do not need to engage in all of these activities to be effective, but they may want to choose two or three that make the most sense in their circumstances. Here are 11 practical ideas:

1) Request a personal meeting with your member of Congress or US Senator. Call the scheduler or chief of staff in the Congressional office to arrange the meeting. If Congress is on recess, schedule a meeting when the member is back in the home district or state. A meeting with a Congressional staffer who handles health care legislation can be productive if the member is not available for the meeting.

2) Bring written materials to leave with your member of Congress. Always prepare a solution for every problem you present (for example, cosponsor Hobson-Tanner HR 3559).

3) Put a face on home care consumers. Include patients or their family members in your meeting, if possible. Provide testimonials and photographs of consumers. Make a video in which your patients, their caregivers, and your staff talk about what home care means to them. Show this video when you meet with your members of Congress and local reporters.

4) Ask your member of Congress to accompany your staff on a visit to a patient’s home. Invite the press to participate with permission of the patient and the member of Congress.

5) Ask for a commitment from your member of Congress. You might want to ask him or her to cosponsor a specific bill, write about your concerns to the CMS Administrator, talk to the chair of a committee that handles the issue, or go on a site tour or home visit with you.

6) Attend town hall meetings sponsored by your member of Congress and US Senators. Raise your issues publicly and ask for a commitment.

7) Have an open house at your facility or present a forum featuring employees, consumers, and caregivers addressing the value of home care to them. Emphasize that home care is cost-effective, clinically effective, and consumer preferred. Ask your member of Congress and other candidates to speak. Invite the press to attend.

8) Be a knowledgeable resource on health care policy issues on which your member of Congress or other candidates can rely.

9) Write letters to the editor, op-ed pieces, and human interest articles for your local newspapers.

10) Cultivate your local media, including newspapers, radio, television, and cable access TV. Become an expert resource on whom they can rely.

11) Issue press releases about innovative programs and unique aspects of your services. Details about trends in your area are important to the local media. Put a human face on key issues by talking about the service, care, and equipment your organization provides. Also, produce public service announcements about home care.

US Health and Human Services Secretary Mike Leavitt is urging the states to rebalance their Medicaid programs between institutional and home-based services. What’s good for Medicaid also makes sense for Medicare. Strengthening the availability of home care for Americans is an important part of the answer to the fiscal and quality transformation challenges of both Medicare and Medicaid. Home care providers will need to drive home that value message to their members of Congress throughout 2006. DP

Ann Howard is director of federal policy for AAHomecare, Alexandria, Va. She can be reached via e-mail: ahoward@aahomecare.org.