Congress and the White House late last week reached agreement on a $500 billion government spending package that might provide more money to home health agencies.
Because the home health deal was reached a few hours after Republican leaders announced the agreement on the comprehensive spending package, lawmakers now must reach a consensus on including it in the spending bill. That should be known this week. Senate Majority Leader Trent Lott (R-Miss.) said the home health measure could face House and Senate votes in a separate bill.
The overall budget package still must be approved by both houses of Congress, probably early this week so that lawmakers can return to their homes to campaign for upcoming elections. The agreement would cover spending for fiscal 1999, which began Oct. 1.
The home health plan was driven by home health agencies that contend the cost caps imposed by the Balanced Budget Act of 1997 are putting them out of business.
Congress agreed to boost fees in 1999 and 2000 but will rein in spending growth after that.
The home health measure would raise both the per-beneficiary and per-agency limits that went into effect Oct. 1, 1997.
The new Medicare home health reimbursement system was enacted as part of last year's balanced-budget law. The system is a stopgap measure that will be in effect only until a new home health prospective payment system begins in 2000.
The latest agreement will cost Medicare an additional $1.65 billion between fiscal 1999 and 2003. To pay that, the annual Medicare updates for home health agencies will be reduced by 1.1 percentage points each year from fiscal 2000 to 2003. When implemented in 2000, the annual home health update will be tied to the rate of inflation in the home health sector. That is projected at 3% for fiscal 2000.
Reducing the update by 1.1 percentage points will save about $900 million over five years. The remaining $765 million will come from non-health-related tax changes.
Lawmakers had hoped to wrap up this session of Congress by the end of last week, but they were unable to draft and pass the $500 billion legislation by then. Congress approved another temporary spending measure to fund the government until it passes the spending bill.
As adjournment nears, Congress is sidestepping a final showdown over legislation to expand federal regulatory powers over managed-care plans. Democrats said the failure to pass such legislation will be a top issue in their election campaigns. Elections are set for Nov. 3.
"If there is one issue on which this election should be a referendum, it's this one," said Vice President Al Gore.
The comprehensive spending package bundles together eight of the 13 annual appropriations bills for federal fiscal 1999 that had yet to pass Congress.
Among them was the appropriations bill for HHS, which frequently becomes a target for controversial amendments on such issues as abortion and contraception.
The HHS provisions would:
Suspend for a year an HHS regulation that requires more regional and national distribution of scarce transplant organs, based on medical need. The regulation, published in the Federal Register in April, aimed to equalize waiting times across the country and reduce the number of patients who die because they can't get an organ.
Provide $25 million for a program created by last year's balanced-budget act that aids development of rural provider networks. The money had been omitted from House legislation.
Physician groups successfully repelled an effort to expand the Drug Enforcement Administration's authority to investigate physicians in cases of suspected assisted suicide.
The expansion measure's chief sponsor, Assistant Majority Leader Don Nickles (R-Okla.), pledged to bring similar legislation back before the Senate next year.
The appropriations bill funding the Department of Veterans Affairs was one of the bills that reached President Clinton's desk last week, although it had yet to be signed.
That bill includes $17.3 billion in funding for the VA's healthcare system in federal fiscal 1999. The amount represents a 1.5% increase over fiscal 1998 in the government's share of spending for the VA system and about 1.6% more than President Clinton requested for the VA in fiscal 1999.