But the $35B Medicare Giveback from Congress Leaves HME Industry Wanting

Washington Nearly $35 billion will be restored to the health care industry over a five-year period under provisions of the recently passed Medicare, Medicaid and SCHIP Benefits Improvement and Protection Act of 2000. The amount is more than double the $16 billion giveback under the 1999 Balanced Budget Refinement Act.

Under the revised giveback package, $12 billion will be restored to hospitals, $11 billion to managed care, $4 billion to nursing homes and home health agencies and $3 billion to other providers. Additionally, $5 billion is provided to lower Medicare recipients' out-of-pocket costs for hospital visits and to expand benefits covering colon cancer treatments and glaucoma and Pap smear screenings.

Although the home care industry achieved some of its legislative goals, the push to have medical supplies carved out of per-episode payments under the home health prospective payment system was not included in the giveback legislation.

The following provisions are part of the revised giveback legislation:

- a full Consumer Price Index inflation update for durable medical equipment in 2001, phased in during the year;

- a delay in the implementation of drug payment reductions under Average Wholesale Pricing and a General Accounting Office study due no later than nine months after enactment;

- a GAO study on costs to HHAs for purchasing nonroutine medical supplies;

- a one-year delay of the 15 percent payment reduction for home health services;

- clarification of the "homebound" definition;

- clarification of the use of telehealth in delivery of home health services;

- clarification of criteria for branch offices and a GAO study on supervision of home health care provided in rural areas;

- a temporary 10 percent increase for home health services supplied in rural areas;

- and revisions to the Medicare appeals process.