WASHINGTON — The good news for Medicare beneficiaries: Despite dramatic declines in the number of home health agencies nationwide, nurses and aides are still widely available to elderly patients who qualify tp receive certain health care services at home.

Benefits patients can receive at home

Medicare will pay for certain home health care services. To qualify, beneficiaries must:     • Be enrolled in Medicare Part A or Part B.     • Be certified by a physician as meeting eligibility requirements.     • Be homebound to the extent that leaving home requires a considerable and taxing effort.     • Require skilled nursing or skilled therapy services on an intermittent or part-time basis.     Benefits include these:     • Up to 35 hours a week of skilled nursing and home health aide services; medical social services; skilled therapy; skilled nursing of less than eight hours a day or intermittent for less than seven days a week.     • Medical supplies, except drugs and some biological supplies.     • Durable medical equipment, covered at 80 percent of Medicare-approved amount.     • Previous hospitalization is not required. There are no premiums or co-payments.     Source: Medicare Rights Center

        The bad news: The government is preparing to cut home health payments 15 percent by Oct. 1.

        Industry officials and a number of lawmakers want the 15 percent reduction canceled, saying cuts have gone far enough.

        Since 1997, Medicare home health spending has fallen, and 1 million fewer patients now receive those services. Among elderly Medicare beneficiaries who qualify for home care, the average number of visits received from nurses and aides has dropped dramatically.

        The reversal was precipitated by strict new payment rules designed to curb home health spending that had skyrocketed during the 1990s. Simultaneously, Justice Department and government auditors aggressively began pursuing fraud and abuse in the home health sector.

        Hundreds of agencies closed, but no evidence is conclusive that Medicare patients have suffered.

        In fact, the Medicare Payment Advisory Commission recently reported to Congress that home health market conditions have stabilized and beneficiaries are not having difficulty accessing services.

        However, the advisory panel joined a growing chorus in recommending scrapping the 15 percent cut, required by the 1997 Balanced Budget Act.

        “We strongly believe that another round of cuts will put a larger number of agencies out of business, and it will cause a real problem for seniors to access those services,” said Ron Malone, president of Gentiva Home Health in Melville, N.Y. The company owns 350 licensed and certified home health agencies across the country.

        More than 100 House members have signed a document calling for elimination of the 15 percent payment reduction.

        Physicians, hospitals, rural hospitals and skilled nursing facilities all want higher Medicare payments.

        Thursday, the Health and Human Services secretary, Tommy Thompson, and the White House budget director, Mitch Daniels, sent Congress a letter downplaying the likelihood the administration would support increased Medicare spending.

        “We have no compelling evidence that there is a problem with the overall adequacy of provider payments,” the two officials wrote.

        The 15 percent cut is actually a misnomer, according to a White House fact sheet. The Centers for Medicare and Medicaid Services actuary estimates most home health agencies will see a net reduction of about 4.9 percent.

        Home health spending is projected to increase 42 percent this year to $13.2 billion and another 12.2 percent to $14.8 billion in fiscal 2003, they pointed out.

        Home health industry officials contend administration projections consistently overstate actual spending and that the 2002 and 2003 increases reflect one-time accounting adjustments.

        Eliminating payment reductions would wipe out the Bush administration's proposal to set aside $190 billion in the next 10 years to add new benefits.

        Further complicating the debate over Medicare spending is AARP, the powerful seniors lobby. It has informed Congress it would strongly oppose any payment increases to providers, including home health agencies, until lawmakers approve a Medicare outpatient drug benefit.

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