Action Alert

Contact Members of Congress to Support Home Health and Hospice Services

Background

NAHC LAUNCHES GRASSROOTS CAMPAIGN TO ENSURE ADEQUATE AND APPROPRIATE PAYMENT FOR HOME HEATLH AND HOSPICE SERVICES

At the beginning of 2008, President Bush proposed in his budget to take $11.03 billion out of Medicare home health spending by freezing payments for five years (FY09-FY13) and instituting a permanent cut in the inflation update of 0.65 percent thereafter. (The Medicare Payment Advisory Commission (MedPAC) recommended a one year home health payment freeze.) The President’s budget made no provision for reinstating the 5 percent add-on payment for home health services in rural areas, which expired January 1, 2007. His budget would have cut hospice payments by $5.14 billion over five years through a three-year freeze and a permanent reduction of 0.65 percent to the hospice update beginning in FY12.

Congress enacted Medicare legislation (H.R. 6331; Public Law No: 110-275) in 2008 that rejected the President’s proposals to freeze home health and hospice payments and permanently reduce the home health and hospice inflation updates. The legislation did not reinstate the home health rural add-on.

The Centers for Medicare & Medicaid Services (CMS) administratively has promulgated a 2.75 percent across-the-board rate reduction for home health services for 2008, 2009, and 2010, as well as a 2.71 percent cut for 2011. Over the next five years (09-13) this provision would reduce outlays for home health by $7.59 billion. This reduction is based on an unfounded allegation by CMS that case mix weights have increased without attendant changes in patient characteristics, referred to by CMS as “case mix creep or upcoding.” Senators Susan Collins (R-ME) and Robert Casey (D-PA) and Representatives Jim McGovern (D-MA) and Walter Jones (R-NC) have introduced the “Home Health Care Access Protection Act” (S. 2181/H.R. 3865) to block implementation of these regulatory cuts and require a transparent new process and criteria for evaluating case mix changes.

CMS also proposed through regulation to cut hospice payments by $2.29 billion by eliminating the budget neutrality adjustment to the hospice wage index. Representatives Chris Van Hollen (D-MD), Jim Ramstad (R-MN), and Maurice Hinchey (D-NY), and Senators Arlen Specter (R-PA), Tom Harkin (D-IA), Pat Roberts (R-KS), Ron Wyden (D-OR), Susan Collins (R-ME), Jay Rockefeller (D-WV), and Gordon Smith (R-OR) have introduced the “Medicare Hospice Protection Act” (H.R. 6873/S. 3484), which would block for one year the implementation of this regulatory cut.

NAHC launched an aggressive campaign asking Members of Congress to: (1) reject home health and hospice payment cuts and reinstate the 5 percent rural add-on; and (2) block the CMS regulatory cuts in home health and hospice payments. Members of Congress are also urged to cosponsor the "Home Health Care Access Protection Act" (S. 2181/H.R. 3865) and the "Medicare Hospice Protection Act" (S. 3484/H.R. 6873).

Although the home health and hospice communities succeeded in defeating the President’s proposals to freeze and permanently reduce the inflation updates, further Congressional action is needed in 2009 to reinstate the rural add-on and block the CMS regulatory cuts in home health and hospice payments.

As a result of the recent economic downturn, states faced with declining revenues and budget deficits are effectuating or threatening reductions in their home and community-based care programs as part of their efforts to control and reduce Medicaid spending. NAHC strongly supports an increase in the federal contribution to state Medicaid programs as part of an early 2009 economic stimulus package.

NAHC has prepared the following tools for this grassroots campaign--including a sample grassroots letter, fact sheet, and impact data-to assist home care and hospice providers as they communicate with their Members of Congress.

Home Health and Hospice Action Alert

TAKE ACTION NOW!

HOME HEALTH AND HOSPICE GRASS ROOTS LETTER TO CONGRESS --

HOME HEALTH CARE

FACT SHEET

1. Ensure Adequate and Appropriate Payment For Medicare Home Health Services

2. Home Health Care Access Protection Act (H.R. 3865 and S. 2181)

a) To View a List of Representatives Who Have Co-Sponsored H.R. 3865 click here.

b) To View a List of Senators Who Have Co-Sponsored S. 2181 click here.

IMPACT DATA

State Medicare Home Health Projected Losses from the President's Fiscal Year 2009 Proposed Budget

Percent of Home Health Agencies, By State, with NEGATIVE Margins in 2008, 2009, 2010, 2011, 2012 and 2013 if the 5-year Market Basket Freeze and CMS Case Mix Adjustment were implemented

HOSPICE

FACT SHEET

1. Preserve the Full Hospice Market Basket Update and the Budget Neutrality Adjustment to the Hospice Wage Index

2. Medicare Hospice Protection Act of 2008 (H.R. 6873 and S. 3484)

a) To View a List of Representatives Who Have Co-Sponsored H.R. 6873 click here.

b) To View a List of Senators Who Have Co-Sponsored S. 3484 click here.

3. Duke Hospice Cost Savings Study

IMPACT DATA

State-by-State Projected Losses in the Medicare Hospice Program as proposed by the President's Fiscal Year 2009 Budget.

MEDICAID HOME AND COMMUNITY-BASED CARE

Support an Increase in the Federal Medicaid Match (FMAP)

HOUSE AND SENATE CONTACT INFORMATION

To find out the name of your Representative and Senators click here.

To view contact information for Representatives and Senators click here. (updated 10/22/09)