Thursday, February 23, 2017

Reimbursement Cuts to NY Medicaid Incontinence Supplies

One Month Delay in Effect While Further Review Takes Place

Last June, The New York State Department of Health (NYS DOH) announced an ‘Incontinence Supply Management Program’ for all Medicaid beneficiaries that would implement minimum quality standards for incontinence products to take effect on September 1, 2016.  In addition to the quality standards, NY DOH also awarded a preferred vendor contract to TwinMed, LLC for incontinence products to be purchased by Medicaid providers.  Medicaid providers who purchase incontinence supplies from TwinMed, LLC were to receive competitive pricing and an approved formulary by the Department as meeting the new minimum quality standards.

While providers are not mandated to purchase these products from TwinMed, LLC, if they purchase from other vendors, they are required to obtain independent laboratory testing results certifying that the products dispensed meet the minimum quality standards. These results must be maintained by the provider for each product and kept on file for a 6-year period in the event of a pre- and/or post-pay audit.

Both AAHomecare and Northeast Medical Equipment Providers Association (NEMEP) applaud the initiative to provide high quality incontinence products to the NY Medicaid beneficiaries. However, along with these developments, the NYS DOH published fee schedule changes for these products that decreased reimbursement by approximately 30% to go into effect on February 15, 2017.

Laura Williard, AAHomecare senior director of payer relations, developed and performed a mini cost analysis study that evaluated providers’ cost of goods along with operational costs to providing these products.  This aggregate, de-identified information was presented to the Department along with comparisons of current and proposed rates with the average Medicaid allowables across the country and also with the 5 surrounding states.

Kim Voelker, NEMEP executive director, was informed that the implementation of rate reductions would be postponed until March 15, 2017 while further review takes place. Going forward, Voelker and Williard will be meeting with the Department to review the study more fully and to advocate on behalf of providers regarding the sustainability of the cuts.  Voelker comments: “Our collaboration with Laura and AAH enabled NEMEP to provide the Department with solid data illustrating providers’ true costs in supplying these products. We look forward to a continued dialogue and re-evaluation of the reimbursement model."

Wednesday, February 1, 2017

CMS Double Dips on Oxygen Payments


“Today rural America oxygen payments are lower than urban competitive bid payments - that’s egregious,” president and CEO of AAHomecare, Tom Ryan, said during his interview with DC’s News Channel8.

“CMS has used an old payment methodology and applied it to the new payment methodology, and essentially double dipped.” Ryan stressed the need to fix CMS’ misguided new cuts for oxygen concentrators in rural areas and HME’s important role in protecting patients and lessening costlier clinical interventions.

The HME industry is a service industry and very often when patients who have difficulty getting in and out of their home receive a visit from their oxygen technician or their respiratory therapist, it’s a life line for them. “That’s the ability for that provider to go in, provide the service, and give them the needed medical equipment. And very often [patients] look forward to their oxygen delivery. They like that interaction with the delivery tech when they come in their door.” This interaction and in home visit is an important part of the healthcare safety net that is now becoming more difficult to provide.

Ryan described the need for rational conversations with CMS with good data and a conversation on where homecare can help save Medicare dollars and still provide better care. “Service is the key here and we too often look at things in DC, and particularly at CMS, in silos. We’ve got to break the silos down and not just look at what does it cost you here but what does it cost you across the whole continuum of care.”

View the full interview: http://wjla.com/news/news-talk/the-affordable-care-act-medicare

Wednesday, January 25, 2017

Our Fight for HME in Washington Takes Many Shapes

A strong voice in Washington is necessary to combat the continued regulatory and legislative battles for homecare – as well as new issues which crop up like the changes from CMS to the 2017 fee schedule for stationary oxygen. AAHomecare is your champion in the halls of Congress and the offices at CMS. We are leading the charge on policy and advocacy in a variety of ways, and one of those is through the use of strong media placements. In 2016, more than seven million people were reached with the positive message of homecare and the detrimental effects of the bidding program.

While the association will do everything in our power to be a strong voice on these issues, having the opportunity to continue working with the media to share provider’s stories helps support the work of industry lobbyist and builds on the education we are providing lawmakers.

These are just a few examples from October alone, of providers and professional healthcare reporters who understand this issue and are reaching out to lawmakers through the power of print:











In addition, our media outreach efforts led to positive editorials in the Las Vegas Review-Journal and the Janesville Gazette (Wisc.), Speaker Paul Ryan’s hometown paper.

One of the ways we support the media efforts is through our Stand Up for Homecare campaign. As Jeffrey Hall, President and CEO of Reliable Medical Supply explains, “If you’re headed to Medtrade then you should be attending the American Association for Homecare event “Stand up for Homecare.” When you purchase your tickets to this great event you are not only buying an opportunity to meet knowledgeable industry leaders, you’re supporting the AAH continued efforts to fight our battles in Washington. Our organization looks forward to this event every Medtrade.”

Won’t you join Reliable Medical Supply and other leaders at this event and support the continued efforts to fight our battles in Washington? These stories in local and national news are making a difference in our fight for fair reimbursement and against regulatory overreach. Learn more about the Stand Up for Homecare campaign and how AAHomecare fights for you.

To share your story and help AAHomecare explain the effects of regulatory overreach and competitive bidding on HME providers and patients, please contact Tilly Gambill at tillyg@aahomecare.org or fill out the online form. Please be assured that all requests for confidentiality will be maintained, and that we will seek prior approval for using any material in media outreach or editorials.

Thursday, January 19, 2017

What's Next? - A Message From AAHomecare's President


As we start the New Year, with a new Congress just getting settled in and a new Presidential Administration beginning in just a couple days, AAHomecare has hit the ground running to ensure we can build on last year’s legislative and regulatory successes and capitalize on potential opportunities for even better public policy outcomes for HME in 2017.  I’d like to give you a quick rundown on what we’ve been focusing on at the start of the year to make that happen.

Rural O2 Payment Policy – As we've recently reported, AAHomecare has asked CMS to reconsider their changes to the 2017 fee schedule for stationary oxygen, resulting from the misguided combination of a 2006 offset balancing rates for portable and stationary oxygen with bidding-derived pricing for rural providers.  While we’ve continued to attempt to engage CMS on this issue, we are now reaching out to Capitol Hill to alert them to this issue and ask them to get involved and are also planning media/PR outreach on the issue if it not quickly resolved.

Competitive Bidding Program – Last year’s success in getting a measure of relief for rural providers for July through December of 2016 will certainly be welcomed by providers when CMS finally announces a refund process (more on that in a moment), but a longer-lasting solution is critically needed.  While our champions on Capitol Hill have expressed their willingness to take up the fight for fairer rural relief policy in the 115th Congress, we’re all too aware of how slowly that process can move.  To that end, we brought in a sub-group of AAHomecare’s Regulatory Council to explore and develop regulatory actions the new administration could take to provide relief for rural providers, especially given that the recent CURES legislation will require HHS to reissue payment regulations to take effect by the start of 2019.  

Reimbursements from Other Payers – We believe that other payers who base their rates on the Medicare fee schedule should provide commensurate retroactive relief for the July 1-Dec. 31 period, where applicable.  We are currently working on our messaging to make this case to TRICARE and Medicare Advantage plans.

Where’s the Refund? –  As I noted above, HME providers in rural and non-bid areas are anxiously awaiting word on the procedures and timing for the relief mandated in the CURES Act – it’s certainly a question that the AAHomecare staff has heard repeatedly from our members and other HME stakeholders.  We’ve pressed CMS to provide guidance as soon as they can, and you can be sure we’ll share that news with you as quickly as we get it.

We’re Just Getting Started – While AAHomecare helped deliver important gains for the HME community in 2016, we recognize that the HME industry still faces a reimbursement and regulatory environment that is causing many well-established companies to change their business models or shutter their operations – leaving patients and communities with less access to essential home medical equipment.  Be assured that the current AAHomecare team enters 2017 with a renewed commitment to improving the business environment for HME through continued advocacy work on Capitol Hill and at CMS, by building relationships with non-Medicare payers, and by exploring new approaches to reimbursement models for value-based approaches and emerging technologies.  I truly believe this will be our most productive and effective year yet, and I look forward to working with the AAHomecare membership and other HME stakeholders to make it happen. 

To learn more about the work of the American Association for Homecare, or to join us, please visit www.aahomecare.org or contact Michael Nicol at michaeln@aahomecare.org.  

Friday, December 2, 2016

Glimmer of Hope for HME- CURES Bill Passes and Rep. Price Named HHS Secretary

This week the House of Representatives passed the 21st Century Cures Act, by a vote of 392 to 26. The bill is expected to move to the Senate next week and the Obama Administration has already weighed in expressing support for the legislation.

The legislation sets the stage for possible future regulatory relief for rural providers, as it requires HHS to reissue payment regulations for items and services furnished on or after January 1, 2019, with adjustments to the non-bid fee schedule in some areas based on stakeholder input, costs, volumes, and numbers of suppliers serving those areas.

Specifically, the legislation will provide six months’ worth of retroactive relief for the second phase of bidding-derived cuts for rural and non-bid area providers; delays the application of bidding-derived pricing reductions for complex rehab technology accessories used with Group 3 power wheelchairs for an additional six months; accelerates the application of plans to limit state Medicaid reimbursement amounts for HME to the Medicare fee-for-service payment rates, including applicable competitive bidding rates, by one year, to Jan. 1, 2018; and also instructs HHS to conduct a study on the impact of the bidding program on the overall number of HME providers and availability of HME products over the course of 2016.

While AAHomecare and other HME stakeholders advocated for a longer delay for the second phase of bidding derived cuts, this legislation marks an important step in efforts to scale back the effects of the bidding program.  Both chambers of Congress, along with party and committee leadership, have recognized that the home medical equipment community in rural areas needs relief and that the bidding program requires more scrutiny.

These measures set the stage for working with the new Administration to move towards more sustainable Medicare reimbursement policies for all HME providers, as well as again taking up these issues in the 115th Congress.

Also this week, President-elect Donald Trump announced he will appoint Congressman Tom Price (R-Ga.) to serve as Secretary of Health and Human Services in his Administration.  Price, who has represented Georgia’s 6th Congressional District since 2004, has been a consistent advocate for better public policy in the healthcare arena and has championed legislation to make sure that patients who rely on home medical equipment have access to those products and related services.

Seema Verma, founder and president of health policy consulting firm SVC Inc., was selected to serve as Administrator of the Centers for Medicare and Medicaid Services.