Thursday, September 21, 2017

Concerns Continue for Access to Durable Goods at State Level

Access Press published a piece on the plight of homecare providers in Minnesota and a current law requiring Minnesota to bid out incontinence products:
The Midwest Association of Medical Equipment Suppliers (MAMES), its members and other advocates are asking to overturn a law requiring Minnesota to bid out incontinence products. The law was tucked into the 2017 health and human service omnibus bill in the final hours of the legislative session. Bill Amberg, who is MAMES’ lobbyist, said member medical supply dealers are frustrated that the bill addition came without debate or discussing. “There wasn’t even a conversation with stakeholders.”
MAMES and its allies are working to overturn the bid requirement before it takes effect next year. That could happen during the 2018 legislative session.
Amberg said that if the change goes into effect next year, it would be yet another blow to Minnesota’s medical supply and durable medical equipment providers. More than half a dozen companies have closed during the past year including longtime Twin Cities firm Key Medical Supply. Key had waged a long and ultimately unsuccessful legal battle over the Centers for Medicare and Medicaid Services’ (CMS) competitive bidding program as it related to enteral nutrition supplies or feeding tubes.
It will also inconvenience many people who need the incontinence supplies for daily living. “It just gets tougher for people with disabilities and senior citizens,” Amberg said. “They can’t find caregivers, they can’t have reliable supplies and medical equipment for their daily lives. It’s hard to talk about people staying in their home communities on one hand and forcing them out on the other.”

Thursday, July 6, 2017

Stemming the Tide Through Payer Relations

As reported in Wednesday in Washington, AAHomecare remains focused on legislative and regulatory strategies to move the industry forward. But our investment in payer relations has also produced impressive returns for HME providers in our first year focusing on this area.

“With increasing pressure to save money on state budgets, it’s critical that we have a strong capability to help respond to proposed Medicaid rate cuts and rally providers and state associations to advocate for fair reimbursement policies,” explains Tom Ryan, AAHomecare’s president and CEO.

In just one year, AAHomecare has been successful in stemming the tide and in some cases reversing further cuts with the help of state associations, utilizing a multi-pronged approach. Here are just a few results:

  1. With the aid of AAHomecare’s Dobson DaVanzo Study which analyzes the full operational costs plus cost of goods against the current Medicare reimbursement environment, the industry has effectively negotiated pricing agreements for DMEPOS providers with state and national payers. 
  2. The Association consulted with legal staff on how the CURES Bill impacted TRICARE, Medicare Advantage, and Managed Care payers. AAHomecare provided a reference for the industry to use in discussions with payers on getting July-December 2016 claims reprocessed. The Association also worked with Brown & Fortunato to obtain legal opinion on the rights and responsibilities of the states in implementing CURES language.
  3. Over the course of the year, AAHomecare has built relationships with many private payers that directly impact the health of our industry and future reimbursement decisions. On the national level, payers included Anthem, TRICARE, the Defense Health Agency, AIM Sleep Management, and Carecentrix. We believe these relationships will build to greater impact on policy and operational changes for HME providers.
  4. At the state level, AAHomecare has worked with regional associations to secure wins in several states who were following suit with Medicare reimbursement. These include working with NEMEP to secure a freeze of current rates until further notice with the New York Medicaid Incontinence Program. AAHomecare also joined Big Sky Association of Medical Equipment Suppliers to evaluate strategy and create a white paper for presentation to BCBS Montana regarding reimbursement cuts to the 2017 fee schedule. Further, in conjunction with the Maryland-National Capital Homecare Association, AAHomecare worked to establish a strategy for fighting pricing cuts with DC Medicaid. We have received notice the Agency is evaluating the information given and analyzing the budget before finalizing decisions, but expect changes to be made.

Williard Elevated to Vice President Role

These efforts on behalf of AAHomecare have been led by AAHomecare’s Laura Williard, who the Association has just promoted to Vice President of Payer Relations. “Laura Williard has brought significant expertise and energy to her role as leader of our payer relations efforts,” said Ryan. “She has gained a great deal of credibility with HME providers and has established solid relationships with state healthcare stakeholders and other major payer organizations.”

You can read a more extensive review on payer relations efforts and the work of Laura Williard here.

Laura can be reached at – and follow her on Twitter: @WilliardLaura.

Monday, June 26, 2017

CMS Announces Long-Term Relief on CRT Accessories

Policy Change Marks an Important Win for CRT Providers and Patients Who Depend on Highly Specialized Mobility Products

The Centers for Medicare & Medicaid Services announced that accessories for group 3 power Complex Rehab Technology (CRT) mobility products will continue to remain exempt from the application of competitive bidding derived pricing for Medicare beneficiaries.  Congress has twice passed legislation delaying the application of bidding derived pricing, including a six-month delay as part of last December’s CURES bill that was set to expire on June 30.  This policy change, announced here by CMS, essentially extends the CURES provisions indefinitely.  From CMS’ announcement:

CMS is issuing a new policy on how adjustments to the fee schedule based on information from competitive bidding programs apply to wheelchair accessories and back and seat cushions used with group 3 complex rehabilitative power wheelchairs.  Section 16005 of the 21st Century Cures Act currently allows higher payments for these items but is set to expire after June 30, 2017. By continuing these higher payments, this new action will help to protect access to complex rehabilitative power wheelchair accessories on which people with significant disabilities depend.

The full release and AAHomecare president Tom Ryan's remarks on this issue can be found in the Association's press release.

Friday, May 19, 2017

DMEPOS RAC to Look at Potential Underpayments for Group 3 Wheelchair Options & Accessories

The industry is pleased to see that Performant Recovery, the DMEPOS RAC, has been approved to add an audit that will look at the underpayment of Group 3 power wheelchair options.  All wheelchair accessories (including seating systems) and seat and back cushions furnished in connection with Group 3 complex rehabilitative power wheelchairs will be reviewed regardless of modifiers.  This issue recovers the incorrect reductions owed to suppliers for claims for these items for DOS 1/1/2016 - 6/30/2016.

This is a very positive development as it is the first time an underpayment for our industry has been audited!

Monday, May 8, 2017

Industry Advocate Kucka To Receive Award at #AAHWLC17

AAHomecare is pleased to announce George Kucka will be the recipient of this year’s AAHomecare/Mal Mixon Legislative Advocate Award at our upcoming Washington Legislative Conference on May 24-25, 2017 in Washington, DC.

The Legislative Advocate Award was established in 2012 to recognize and honor AAHomecare members who have significantly advanced the homecare community’s legislative goals and who have, by their example, inspired and motivated others to join the fight for better federal policy for the home medical equipment sector. Last year the Association honored Thad Connally, president of First Choice Medical.

George Kucka, president of Fairmeadows Home Health Center, Inc. in Schererville, Indiana, has dedicated his career to serving others. As a member of the AAHomecare Board of Directors, chair of the HME/RT Council, and active member of several of the Association's Councils and Work Groups, he has been deeply involved in the decisions that are building a better future for HME.

Kucka has faithfully championed the benefits of membership in both national and state associations and served as a catalyst for action in the industry, including serving as a driver behind the efforts to develop a definition that more fully encompasses the value of HME that will have wide effects and applications in our field. His knowledge of industry processes and protocol have helped identify opportunities to pursue better systems for providers to serve patients and their communities.

The 2017 AAHomecare/Mal Mixon Legislative Advocate Award will be presented to Kucka during the Legislative Conference on Wednesday, May 24, in the Grand Ballroom at the Washington Court Hotel in Washington, DC. Register today for the conference and be there to support a colleague and strong advocate for this industry.