WASHINGTON — After a weeks-long wait as the New Oxygen Committee's oxygen reform bill was drafted into legislative language, the American Association for Homecare reported last week it expects the bill to be introduced today by Rep. Mike Ross, D-Ark., a former HME owner.
"We expect the budget-neutral oxygen reform bill to be introduced in the House by Monday, and we're very happy to have an influential champion in Congressman Mike Ross," said AAHomecare President Tyler Wilson. He added the association held a strategy call Friday "which gathered a representative group of AAHomecare members who could speak for all sectors of the HME community to make sure we are working in a coordinated fashion both on the Ross bill and in counteracting threats of further cuts to the oxygen benefit."
Among other things, the overhaul plan crafted by the NOC would eliminate the 36-month cap on oxygen, exempt oxygen from competitive bidding and recognize the services required in providing home oxygen therapy. Committee members split, however, on the addition of two provisions to the original 13-point plan that would change status from oxygen "supplier" to "provider" and add measures on cost reporting. The plan moved to bill-drafting stage with the controversial provisions intact. (For more, see Industry Scrambles to Unite on Oxygen Reform, March 30.)
In June, Ross sent a letter signed by 70 other representatives to several key House committees as a "placeholder" for the bill, requesting that reform of the Medicare oxygen benefit be included in health care reform legislation this year.
But the Ross bill is not the only oxygen reform proposal that has made its way to Congress.
According to a press release issued Friday, both the House Ways and Means and the Senate Finance committees asked for a "simplified" oxygen proposal from the Committee to Save Independent HME Suppliers and the National Association of Independent Medical Equipment Suppliers.
After the groups met in early June with staff from both committees — charged with drafting overall health reform legislation — Wayne Stanfield, NAIMES president and CEO, said they requested an oxygen reform plan that would:
- Bundle payments for all oxygen equipment, suppliers and service provided to any given patient into two categories;
- Establish a means for appropriate qualification of patients for these bundled oxygen therapy categories based on objective criteria; and
- Come out budget-neutral or with a savings.
The CSIHME Legislative Affairs Board drafted a document called the Home Oxygen Therapy Service, or HOTS, plan that incorporates "many of the same fundamental concepts" as those in the NOC plan, Stanfield said. It would end the 36-month cap, include elements of a service component, require an Office of Inspector General study of the actual cost of home oxygen services and create an oxygen benefit advisory panel.
But the plan differs from the NOC plan, he said, because "there is no provider status, no cost reporting and there are no geographic index adjustments ... Our plan is essentially the original 13-point [NOC] plan with modifications to match what Ways and Means asked us to do."
Stanfield said CSIHME/NAIMES completed its plan in less than a week after the Capitol Hill meetings and presented it to both committees "by the deadline they wanted" last month.
CSIHME/NAIMES said the HOTS plan:
- Results in a budget savings of more than $1.2 billion over five years. "That's based on our numbers," Stanfield said, "but the [Congressional Budget Office] may see it differently."
- Addresses utilization issues by eliminating migration of patients to a higher reimbursement category.
- Eliminates the cap on payments for home oxygen therapy.
- Addresses stated concerns with the payments for stationary oxygen concentrators.
- Simplifies the solution to make it acceptable to Congress and CMS.
- Does not affect competitive bidding, which must be addressed on its own.
- Addresses the known concerns of patients, physicians and suppliers.
- Addresses the fact that oxygen is a drug regulated by the FDA.
- Is modality-neutral and allows appropriate payments for new technology such as oxygen-generating portable equipment and home transfilling equipment.
- Notes these individual components are linked inextricably and must be taken together to ensure the full savings and streamlined process.
- Notes the plan is based on recent industry consensus among small business oxygen providers.
"It was clear from discussion with the committees that there was a concern with the complexity of the other proposal," Stanfield said, adding that the HOTS alternative "does the things necessary to protect patients, end the cap and adjust the reimbursement to offer a savings ... We felt like offering savings was important, and it addresses the high cost of concentrators."
Stanfield said he expected most or "cherry-picked parts" of the HOTS plan would be included as part of the Senate Finance Committee's health reform bill. "And it might be mentioned in the House draft bill, although they may defer the oxygen plan to the Senate," he said.
Stanfield said the proposal has also been given to the Energy and Commerce Committee, which, along with the Ways and Means and Education and Labor committees, has jurisdiction over health care reform in the House.
Some HME stakeholders have said they're worried the industry divide over oxygen reform could hurt its chances — and those of ending the 36-month cap — as health reform progresses.
But Stanfield said he doesn't see any confusion in Congress. "They are asking what do we want, and we are telling them," he said.
