Does HCFA need legislation to delay hospital and physician Medicare reimbursement updates and the implementation of new outpatient and home health prospective payment systems or doesn't it?
At this point, no one seems to know.
Last week, at a hearing of the House Ways and Means health subcommittee, HCFA Administrator Nancy-Ann Min DeParle said HCFA would "work with this committee to evaluate whether legislative changes are needed."
Rep. William Thomas (R-Calif.), subcommittee chairman, said he was concerned that "laws are being changed not by the courts but by administrative fiat."
Last month DeParle sent a memo to HHS Assistant Secretary Kevin Thurm stating that because HCFA needed to devote more resources to fixing the year-2000 computer problem, hospitals and physicians would not receive their annual Medicare payment updates for fiscal 2000 on time. Hospitals' Oct. 1, 1999, update and doctors' Jan. 1, 2000, update will be delayed until April 2000. Payments will be made thereafter at rates that will yield a full year's update by the end of the budget year.
HCFA also plans to indefinitely delay implementation of the new PPS for home health and outpatient care. Those new systems were enacted as part of last year's balanced-budget law.
But now the question arises: Does HCFA need Congress to sign off on the changes or can the agency make them unilaterally?
Aides to Thomas say they believe legislation is needed. Thomas himself said he is concerned that HCFA is using resource constraints as an excuse to get around Congress' intent or to avoid implementing provisions it disagrees with.
The American Hospital Association also said legislation is needed to delay the payment updates and delay implementation of the new PPS systems.
"(HCFA has) been doing these updates for 15 years," said Richard Pollack, AHA executive vice president of federal relations. "It is not a complicated matter, and there ought to be an alternative to simply delaying the updates."
Pollack added that if the payment updates are delayed, HCFA should pay providers interest on the amount that would otherwise have been paid to providers.