The HME community is apprehensively counting down until July 1, the deadline for implementation of phase II of CMS’ flawed competitive bidding process to non-Competitively Bid Areas (CBAs). Congresmust act now to stop the spread of bidding to additional rural areas and keep this program from further decimating the home medical equipment safety net that supports some of our most vulnerable patient populations.
Why Is This Program Detrimental?
Phase I of the reimbursement adjustment took effect on January 1, 2016. And just six months later, phase II is expected to begin, however the American Association for Homecare and many consumer groups and partners in the DME community believe six months to monitor for disruption in Medicare beneficiaries’ access to DME items in rural areas is not enough time.
Rural America has unique attributes with distinct costs that differ from their urban counterparts. The HME Industry has convincing data that indicated providing DME items in rural areas have higher costs in order to access, care for, and support non-urban and rural beneficiaries, which are not accounted for in the regional single price amount, such as:
· Employee time, fuel costs, and mileage to drive to the beneficiary’s residence
· Widely ranging geological and road characteristics that could require specialty vehicles, including 4-wheel drive, ATVs, tractors, snowmobiles, ferry coordination, and more Sparsely populated areas that don’t offer the same routing efficiencies as dense urban areas
· Suppliers in non-CBAs will not have economies of scale to offset the drastic payment cuts. In CBAs, suppliers try to offset the significant payment cuts through increased volume of beneficiaries while supplementing payments with serving markets outside the CBA. However, under this forthcoming mandate to expand the program nationally, suppliers in non-CBAs will receive the same drastic payment cuts set in CBAs, without exclusive contracts and increase in volume of business or the ability to compensate with higher rates outside of the CBA.
What Can I Do?
AAHomecare is calling on the HME community to commit to making every effort to encourage Congress to support legislation for rural relief—The Patient Access to Durable Medical Equipment (PADME) Acts, H.R. 5210 and S. 2736. As we head toward the critical final weeks that will decide the issue, our consumer and industry partners are helping to bolster our endeavors with letters of support. A joint letter from national and state associations in support of PADME explains that little independent analysis of the competitive bidding program has been done to evaluate whether the program has “restricted the types of products available for patients or compromised physician decisions to prescribe specific products…”
The ITEM Coalition has endorsed H.R. 5210, and the National Federation of Independent Businesses has weighed in with letters supporting both the Senate and House bills. We encourage you to share these letters with your Congressional members as examples of support from patients and industry associations. You can also share maps showing rural, regional, and CBA areas in your state.
The HHS OIG also released a chilling report confirming that CMS awarded unlicensed bidders to receive contracts in Round Two (more details in next story), that can also help you make the case that current Round 2 rates that helped determine bidding prices for some rural and non-bid regions are based on winning bids from unqualified bidders.
Each of these are powerful tools in your arsenal to fight for rural relief legislation and help swell Senate & House co-sponsor rolls. We encourage you to use everything at your disposal in these final days to help us push legislation into a vote.
Are your Senators and Representative on the list?
New House co-sponsors in the last week:
Rep. Jeff Fortenberry (R-Neb.)
Rep. Kurt Schrader (D-Ore.)
Rep. Pete Visclosky (D-Ind.)
Rep. Ed Whitfield (R-Ky.)
Rep. Chellie Pingree (D-Maine)
full House co-sponsor list (total: 72)
New Senate co-sponsors in the last week:
Sen. Tammy Baldwin (D-Wisc.)
Sen. Mark Kirk (R-Wisc.)
full Senate co-sponsor list (total: 29)
Tuesday, June 7, 2016
Deadline for Rural Relief Legislation Enters Final Month
at 10:00 AM