A season of meetings on Capitol Hill has taught many lessons—some good, some bad, and some ugly—but so much is left to be done.

AHomecare’s government relations staff, representing both HME and home health, have jointly conducted approximately 200 meetings on Capitol Hill in recent months. Depending on the imperative of the moment, these meetings have focused on the value of home care, competitive bidding, oxygen ownership, power mobility device policy and reimbursement rates, and the home health agency reimbursement update.

We have met largely, but not exclusively, with Republican offices on the House side, targeting members of key committees, leadership, and those facing tough reelection races. The focus has been on Republicans because the power of decision lies almost exclusively with the GOP in the House of Representatives, as of press time.

The Senate is a somewhat more bipartisan and harmonious legislative body than the House. By year’s end, we expect to have met with all 100 offices, both Republican and Democrat. Our strategy will adjust depending on what party controls what house of Congress after the November elections.

Almost without exception, these offices have been pleased to meet with us, and grateful that we provided them with comprehensive information and solutions on issues about which they may know a great deal, a little, or in some cases nothing at all. Most members had heard from their constituents, but some had only a sketchy understanding of the issues.

Overall, we found that Congress is very favorably disposed to home care. There is near universal support for the Part A home health benefit, though this does not necessarily translate into stepping forward to champion home health when it is offered up as an offset during conference between the House and Senate.

With few exceptions, Congressional offices are favorable to HME. Several House members, however, were irked by the push back they got from oxygen patients and home oxygen providers on the 36-month oxygen capped rental provision in the Deficit Reduction Act of 2005 (DRA). To help offices respond to oxygen beneficiaries and providers, the key House committees stepped in to provide talking points as a rebuttal to the industry’s arguments about the dangers of oxygen ownership for Medicare beneficiaries.

Nevertheless, even some initial skeptics ended up supporting the Schwarz-Price bill (HR 5513) that would amend the DRA to restore oxygen policy to continuous rental. Other offices that were initially negative on the issue modified their position saying that they would support a mechanism to maintain the professional relationship between beneficiaries and their oxygen providers after 36 months.  

Much as home care is valued, it is still in danger. Congress continues to experience great pressure to address the physician sustainable growth rate (SGR) problem, which will lead to a 5.1% Medicare reimbursement reduction on January 1. This is our problem too. Among the potential “pay-fors” (offsets to pay for a “fix” for physicians) are further reducing the oxygen rental period from 36 to 13 months, and a 1-year or even multi-year freeze on home health reimbursement—though there is little desire to see these cuts occur.  

Physicians may not be their favorite interest group, but members of Congress feel the heat constantly both in Washington and in their home states and districts, and would like to dispense with the problem. The SGR dilemma may be addressed in a lame duck session of Congress beginning on November 13, or it could carry over into the 110th Congress. There is no consensus as of this writing for a 1-year, multi-year, or permanent SGR solution.  

Whether or not the SGR problem is solved, and no matter who controls Congress in 2007, responsible members of both Senate and House will try to focus on three looming fiscal crises in advance of the retirement of 78 million Baby Boomers—Social Security, Medicare, and Medicaid. We know that home care is a big part of the solution for Medicare and Medicaid. It is cost effective, clinically effective, and consumer preferred.

We have collected a number of studies of cost effectiveness and clinical effectiveness, but these tend to be small and self-reported. The industry needs research produced by a highly respected independent entity to objectively demonstrate what we already know to be true.

The Bush Administration has called home care “radically more efficient” and consumer preferred over institutional care, and it is vigorously pushing the 50 states to rebalance their Medicaid programs between institutional and home-based care. This principle is just as valid for Medicare. It is unclear, however, why there is such a disconnect between advocating for more home care in Medicaid while urging home care cuts in Medicare—such as the home health reimbursement freeze and the oxygen rental period reduced to 13 months—as proposed in the Administration’s FY 2007 budget.

The agenda the Democrats could be expected to pursue should they control either or both houses in the 110th Congress is as follows:
• very little legislation due to potentially narrow voting margins; and
• use a major weapon such as oversight hearings, focused on the Part D prescription drug benefit.

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