Regardless of how it deals with the SCHIP reauthorization issue
in September and beyond, Congress will continue this year to pursue
a Medicare bill, driven primarily by the desire to fix the Medicare
physician fee schedule so that doctors don't receive a payment cut
in 2008. The unresolved question is whether this will turn into a
major Medicare bill, with opportunities and vulnerabilities for our
industry, or whether Congress will only pass legislation affecting
physicians.
If a larger bill is addressed, we have opportunities like the
Tanner-Hobson and Conrad-Hatch competitive bidding bills and repeal
of the oxygen equipment ownership mandate. At the same time, there
are vulnerabilities if Congress needs to find ways to pay for
items. Therefore, we must take both the offensive and the
defensive. If you haven't yet communicated these priorities to your
senators and representatives, do it today.
Congress must pass the Tanner-Hobson and Conrad-Hatch
competitive bidding bills
While we currently have 110 members in the House signed on, we
need more! Contact your representatives and senators and ask them
to sign on to H.R. 1845/S. 1428 as a co-sponsor. Congress should
pass these bills because they will better ensure beneficiary access
to quality HME services under competitive acquisition and will
rationalize CMS' implementation of the program.
The bills will allow “any willing provider” to
participate (the Senate bill would limit that provision to
providers with $6 million or less in annual revenues). The House
bill will also require Congress to re-authorize the program before
CMS can expand it beyond the original 10 metropolitan statistical
areas.
The bills aim to ensure competition is maintained in the
marketplace. Approximately 90 percent of DME suppliers are small
businesses, and the bills will facilitate small business
participation in the program.
Congress must reject cuts to the Medicare home oxygen
benefit. The Medicare home oxygen benefit has been cut
significantly over the past few years, and a majority of these cuts
have yet to be realized.
Congress and CMS have enacted, or are in the process of
implementing, significant policy changes to the benefit that will
result in cuts of 19 percent in the next two years. These cuts
include the industry-wide competitive bidding program and a
Medicare payment cap for home oxygen after 36 months.
As Congress deliberates Medicare funding this year, we are
deeply concerned about the threat of additional cuts to the
Medicare benefit. Home oxygen therapy costs about $7.50 per day,
far less than the average cost of more than $3,500 for one day in
the hospital.
Congress should repeal the requirement that beneficiaries
assume ownership of oxygen equipment. Oxygen is a prescription
drug, delivered via a prescription device, and unregulated use
poses significant dangers and burdens for seniors. This change is
budget-neutral, meaning it would not cost the government any
money.
The many co-sponsors of the Home Oxygen Patient Protection Act
(House and Senate bills H.R. 621 and S. 1484), which would repeal
the Deficit Reduction Act oxygen provisions, are a testament to the
ready understanding of the patient safety issues associated when
frail seniors are responsible for complex medical equipment that is
life-sustaining.
Congress should reject any proposal to eliminate the
beneficiary's option to purchase power wheelchairs. Congress
must reject any proposal that would eliminate the beneficiary's
choice to purchase a power wheelchair at the initial month of
medical need. If Congress were to eliminate this option, Medicare
would pay 5 percent more. Also, access would be curtailed because
providers would not have the financial means to cover the
significant upfront costs of these devices.
Medicare consumers who are prescribed a power wheelchair suffer
from long-term debilitating conditions and have lifelong needs for
the power wheelchair. Many of these power wheelchairs are
individually customized and configured to meet the specific medical
needs of the beneficiary.
Congress should pass H.R. 2231, a rehab carve-out from
competitive bidding. The Medicare Access to Complex
Rehabilitation and Assistive Technology Act would exempt complex
rehab and assistive technology from competitive bidding on the
basis that it is highly individualized, would not result in
significant savings for Medicare and beneficiary access would
likely be compromised.
Consistent with H.R. 1845, this bill recognizes that competitive
bidding would have negative impacts on consumers by limiting their
choice of provider and limiting access to high-quality products and
services.
So far, H.R. 2231 has garnered 18 cosponsors. Rehab providers
must ask their representatives and senators to sign on to this
important measure.
Congress should eliminate the “in the home”
restriction for power mobility devices. H.R. 1809, the Medicare
Independent Living Act, would remove the Medicare program's
restrictive “in the home” coverage interpretation for
mobility devices. This bill would significantly improve community
access for Medicare beneficiaries with mobility impairments by
removing a discriminatory restriction that bases the coverage of
mobility devices solely on an individual's mobility needs inside
the home.
A specialist in health care legislation, regulations and
government relations, Cara C. Bachenheimer is vice president,
government relations, for Invacare Corp., Elyria, Ohio.
Bachenheimer previously worked at the law firm of Epstein, Becker
& Green in Washington, D.C., and at the American Association
for Homecare and the Health Industry Distributors Association. You
can reach her by phone at 440/329-6226 or by e-mail at cbachenheimer@invacare.com.
