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Senators Admit Home Health Mistakes

March 31, 1998

WASHINGTON (AP) _ Senators said Tuesday they may have gone too far in trying to save money and inadvertently cut off some Medicare beneficiaries from needed home health care.

``We perhaps went overboard and our efforts here now are to try to correct our mistakes,″ said Sen. Max Baucus, D-Mont.

Baucus was among several lawmakers on the Senate Finance Committee, which oversees Medicare’s budget, who showed up Tuesday when the Special Committee on Aging met to reconsider changes to home health benefits in last year’s balanced budget deal.

``There’s a lot of reluctance on the Hill to do any Medicare legislation this year,″ said Sen. Chuck Grassley, R-Iowa, chairman of the Aging panel. But Grassley said home care is ``not a luxury for our seniors. It’s a necessity, and we just have to make it work.″

Advocates for the elderly and disabled complain that new limits on Medicare payments for home care have led providers to deny services to the sickest beneficiaries.

``The incentive is for them to find the easiest and cheapest patients to care for,″ said Alfred J. Chiplin, Jr., a lawyer for Connecticut’s Center for Medicare Advocacy.

Consequently, many people with more complicated and expensive home care needs, like Marsha Lutwin of Rockway, N.J., have had their services cut.

Lutwin, 47, is among millions of disabled Americans who qualify for Medicare early. Crippled by multiple sclerosis, she can’t leave her bed without help. Until December, a home health aide visited every morning and evening and a nurse came periodically to change her urinary catheter.

Now, her home care agency sends only a morning aide, leaving Lutwin in the evenings to rely on her roommate, who also has MS.

``He’s gone to help me and he’s fallen a couple of times and I couldn’t help him,″ said Lutwin. ``It’s really scary.″

The pair have resorted to calling the police when they need help, which Lutwin calls ``embarrassing″ but better than being institutionalized. That, she said, ``would break my spirit.″

Medicare recently warned home health agencies against cutting off services ordered by doctors. Advocacy groups have intervened on patients’ behalf, but Chiplin said that doesn’t solve the money crunch.

Instead of being paid visit by visit virtually without limit, as in the past, home care agencies starting this year are subject to annual limits on the Medicare payments they can receive.

Congress enacted the change to slow exploding home care costs, which have grown to more than $17 billion a year _ almost 10 percent of Medicare’s total budget. Government auditors reported rampant fraud and misuse of the benefit, saying up to 40 percent of bills should never have been paid.

The new payment limits are based on the number and average cost of patients that home care agencies served in fiscal year 1994. The system is temporary, scheduled for replacement in October 1999 with standard fees for each condition that home health agencies treat. However, budget balancers expected it to save Medicare $1.6 billion this year alone.

``It was not possible to come up with something that everyone would feel was fair while achieving the goal of reduced growth,″ said Medicare administrator Nancy-Ann Min DeParle.

But home care providers argue that well-run agencies are punished the most, since everyone must live within their past budgets. Although there’s no cap on the care individual patients can receive, too many very needy patients can push an agency over the edge.

Cindi Slack, executive director of the Sioux Valley Hospital Visiting Nurses Association in South Dakota, told senators she may have to stop offering care in some remote areas.

``In the worst case scenario, agencies ... may have to dissolve,″ Slack said.

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