Republicans and Democrats on the House Ways and Means Committee today chided the Health Care Financing Administration for failing to provide specific proposals to fix what was to be a temporary home healthcare payment system. Agency officials responded that dealing with the year 2000 computer problem has made such reforms difficult.
Testifying before the Ways and Means Health Subcommittee, HCFA Deputy Administrator Michael Hash said the agency is happy to work with members to legislate changes to the payment system, but offered no specific proposals other than stipulating that changes be budget neutral, have bipartisan support, and not require computer programming changes that conflict with the agency's effort to alleviate the year 2000 problem.
The Y2K problem is part of the current home healthcare political crisis: Last year's Balanced Budget Act required that home health payments be cut an additional 15 percent if HCFA does not implement a new prospective payment system by Oct. 1, 1999. Earlier this summer, HCFA said it could not meet that deadline because of its computer programming work.
In the meantime, groups representing home care providers say the interim payments are cutting deeper than Congress intended--the most recent CBO estimate is that home care spending will fall by $26 billion over the next five years, rather than the $16 billion estimated upon passage of the BBA. The limits also are penalizing some of the most efficient providers, who have kept their costs historically low, say home care providers.
Ways and Means Health Subcommittee Chairman Bill Thomas, R- Calif., said earlier this week he hoped to mark up a bill today that would address the problems, and even floated the possibility of requiring beneficiary copayments, an option rejected last year. But no agreement has been reached, and Thomas was clearly frustrated at the hearing.
"We have to have a solution and it has to be presented as soon as we come back [from the August recess] and it has to mitigate the current problem," he told Hash. He likened HCFA's failure to propose specific solutions to being on an airplane "and finding there's only one parachute and it's already been used."
Thomas' criticisms were echoed by subcommittee ranking member Fortney (Pete) Stark, D-Calif.
"The chairman's request is fair," he told Hash. During August, Stark said, HCFA officials should "stay home and get us a plan that will work."
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