WASHINGTON--With President Bush's 2008 budget proposal expected today, industry stakeholders, alarmed by rumors that it will include provisions harmful to home care, have been gearing up for a response.

In a recent interview with Treasury Secretary Henry Paulson, the Wall Street Journal reported that the president's new budget contains proposals that could generate $90 billion in Medicare savings, mainly from health care providers with some beneficiaries also affected (see HomeCare Monday, Jan. 29).

But as of Friday, Washington insiders said they had received verbal confirmation of two proposals more specific to HME: one for a 13-month cap on home oxygen therapy, and another to eliminate the first-month purchase option for power wheelchairs. The two proposals would be a repeat performance on the president's part, having also been recommended in his 2007 budget (see "Bush Budget Proposes 13-Month O2 Cap," Feb. 13, 2006). Both proposals were defeated after intense lobbying efforts by the industry.

Although implementing any specific budget recommendation the president makes would literally require an act of Congress, HME advocates say the prospect of further cutbacks is threatening.

"A 13-month [oxygen] cap would have a tremendously negative impact, not only on the industry but on patients as well," said Walt Gorski, the American Association for Homecare's vice president of government affairs. "Clearly, we will need to harness the collective efforts of the entire field to fight this proposal if it comes to pass--doing even more than we did last year."

The association "must also work to actively engage our patients to understand the real impact of such a proposal and help tell Congress why it should not be enacted," Gorski said.

Mike Marnhout, president and CEO of Lexington, Ky.-based Bluegrass Oxygen, said that while the current 36-month oxygen rental cap is bad enough, a 13-month cap would be "devastating," causing many providers to be forced out of business and beneficiaries to suffer due to a lack of service.

"For us to save our businesses, [large and small providers are] going to have to join hands, and it's going to have to be a collaborative effort to stop this," Marnhout said.

Last month, Rep. Tom Price, R-Ga., reintroduced the Home Oxygen Patient Protection Act, which would repeal the 36-month cap enacted under the Deficit Reduction Act, but the bill must gain enough support in the House and a companion bill in the Senate to pass.

Regarding elimination of the first-month purchase option for power chairs, Seth Johnson, chair of AAHomecare's Rehab and Assistive Technology Council and director of government affairs for Pride Mobility, said it "does not make sense" for Medicare to rent this equipment. He said a Pride position paper shows that eliminating the purchase option would cost Medicare more money than it would save.

"A very significant majority of the beneficiaries who need a power wheelchair need it because they have a long-term debilitating condition," Johnson said. "They're going to need that device for the rest of their lives."