HCFA Grants Extension for HHAs
March 12, 1998
Medicare home-health agencies (HHAs) breathed a collective sigh of relief when the Health Care Financing Administration (HCFA) granted an indefinite extension to the Feb. 27 deadline for them to obtain surety bonds or to notify the government they couldn't get one.The original final rule, published in the Jan. 5 Federal Register, required that an HHA get a surety bond of at least $50,000 or 15 percent of the agency's annual Medicare payments, whichever is greater. Any HHA not having secured a bond or having notified HCFA of their failure to get one by the Feb. 27 deadline would have been terminated from Medicare. However, HCFA estimates that only one out of seven HHAs were able to secure the required bond. Hence, the agency plans to make some technical changes to the rule and publish a revised version of it in the Federal Register. When that happens, HHAs will have 60 days from the date of publication in which to meet the new requirements. In the meantime, HCFA has called for intermediaries to contact HHAs that failed to obtain a bond or request an extension by the Feb. 27 deadline. Those providers must simply provide a letter, on the HHAs letterhead, stating that it was unable to secure a bond.
According to a letter to Congress from HCFA Administrator Nancy-Ann Min DeParle, the agency will soon publish a notice in the Federal Register detailing proposed changes to the Jan. 5 rule.
New Home Health Care Law Problematic for Small Companies
February 16, 1998
The Balanced Budget Act of 1997 is making it more costly to work in the home care industry. A new law published in the Jan. 5, 1998 Federal Register was intended to help cut down on fraud and abuse by eliminating unstable operations. In the process, however, it could drive many small home health agencies out of business with its new surety bond requirement.Effective beginning Jan. 1, the law requires that home health agencies post a surety bond each year equal to 15% of its Medicare revenues. Because many of these businesses get a majority of their revenues from Medicare, that amount could work out to be well above the minimum required bond amount of $50,000. For a smaller company, posting a bond for such a large amount could pose a serious problem. WhatÕs more, surety bond firms are making it more difficult for smaller companies to get the necessary bonds by requiring collateral and personal guarantees of repayment.
These two strikes work directly against the mom-and-pop type companies, quite possibly putting them out of business. The larger operations, obviously, should be able to take the new requirement in stride. Many of them will actually get a break because HCFA has placed a $3 million cap on the bond amount.
Bonds for home health agencies this year must be posted by Feb. 27.
AARC Raises Concerns About Conditions of Participation That Restrict Home Respiratory Care Services
The American Association for Respiratory Care provided comments on proposed revisions to the Medicare Home Health Agency Conditions of Participation published in the Mar. 10, 1997 Federal Register (an introduction explains the background and application of the revisions). The AARC applauded the Health Care Financing Administration (HCFA) for the proposal's flexibility, but admonished them for allowing only nurses or physical therapists to provide skilled respiratory care as a home health benefit.
"The Conditions continue to ban the one professional who possesses documented competency to deliver such services, the respiratory care practitioner," said AARC Past President Kerry George in a letter to HCFA administrator Bruce Vladeck. "This is tantamount to providing a nursing benefit and prohibiting nurses from delivering it, or a physical therapy benefit prohibiting the physical therapist from providing the service."
According to the Medicare Home Health Manual (the implementing guidelines for the Conditions of Participation), intermittent skilled respiratory therapy visits are a covered service, but only if provided by a nurse or physical therapist.
As part of its comments, the AARC provided Mr. Vladeck with information about the lack of any formal education or competency documentation in respiratory care for any other health providers, and also provided data showing the positive economic and clinical benefit of respiratory care practitioners. Additionally, statements from the American Society of Anesthesiologists and the National Association for Medical Direction of Respiratory Care endorsed the need to use respiratory care practitioners to render respiratory care services.
In addition, the AARC raised the following concerns:
- That the Medicare guidelines are contradictory. The Medicare Hospital Conditions of Participation clearly recognize the critical nature of respiratory care services by establishing a standard of care that requires that there be adequate numbers of respiratory therapists and respiratory therapy technicians to provide these services. Yet Medicare is contradicting itself by not requiring this same standard outside of the hospital.
- That the current Medicare regulations are working against the dynamics of integration of care across all care settings. And at a time when higher acuity patients are being discharged from the hospital, patients must continue to have access to qualified health care providers in the post-acute settings.
- That HCFA is permitting Medicare beneficiaries to receive complex respiratory care by nurses and physical therapists who do not have to demonstrate any respiratory care competency.
The AARC did praise HCFA for turning their focus to providing care in the most appropriate setting, thereby incorporating a flexibility and coordination of services heretofore missing from Medicare standards.
Final issuance of the new conditions may be held up as HCFA prepares for the Oct. 1, 1999 implementation of a prospective payment reimbursement system for this benefit.