A long shot.

Bill would extend Medicare to chronic care

THREE DEMOCRATIC CONGRESSMEN HAVE introduced the Omnibus Long Term Care Act of 1999 (H.R. 2691), which proposes a series of new benefits to move Medicare from being only an acute care program to one that also would allow the chronically ill to remain at home.

The bill is drawing little attention. "We haven't really focused on it as much as other legislation because we don't expect it to move very far," says Robert Greenwood, spokesman for the American Association of Homes and Services for the Aging (AAHSA). He cited the measure's comprehensive nature and its Democratic sponsorship in the Republican-controlled House. It is possible, however, that Republicans might adopt some of its proposals for their own legislation.

Another stumbling block might be its cost, which its principal sponsor, Representative Pete Stark (D-Calif.) has tied to the outcome of tax cut legislation, a contentious partisan issue. No price tag has been placed on the bill, but Stark acknowledges, "It's not cheap." He insists the bill can be financed "if we don't pass a reckless tax cut." Congressional Republicans have passed tax cut legislation that President Clinton has said he will veto.

Sponsors of the bill with Stark are Representatives Edward Markey (D-Mass.) and Jim McGovern (D-Mass.).

Greenwood reports that AAHSA objects to provisions in the measure that would stiffen nursing home requirements. One would require nursing homes to pay for re-surveys and re-inspections regarding quality deficiencies. "That is like a back-door. financial penalty. There already are provisions to levy financial penalties on nursing homes if that is deemed the most appropriate way to get them back into compliance," Greenwood says.

Also objectionable to AAHSA is a proposed requirement that nursing homes post resident-to-staff ratios. "We've never supported staff ratios per se. We want to keep the focus on patient outcomes," Greenwood says.

The bill would establish long term home aide-type care for dependent individuals and long term care for frail individuals if such care would allow them to stay at home; substitute adult day care services for home health services when appropriate; and provide $250 million per year for extra home health payments for difficult cases served before the start of the home health prospective payment system.

Leaders of the American Occupational Therapy Association, Alzheimer's Association, and National Council on Aging (NCOA) attended a Capitol Hill news conference announcing the bill's introduction and expressed their support. "Home and community care, such as adult care, is less expensive than nursing home care," said NCOA president and CEO James Firman.