Your Own Plan of Action

There is no time like today to take your company’s — and our industry’s — future into your own hands.

At press time, the Tanner-Hobson bill (H.R. 1845), which would make substantive improvements to the competitive bidding program, was approaching 100 cosponsors in the House; the Hatch-Conrad version in the Senate (S. 1428) had a dozen cosponsors; and H.R. 2231, the rehab carve-out bill, had about a dozen cosponsors.

It’s time again to focus on contacting your legislators to ask them to sign on to these important bills. If competitive bidding is implemented in its current form, it’s not difficult to imagine a host of scenarios in which consumers end up with a raw deal that could range from substandard equipment to limited service availability — or even worse.

Use the following talking points:

Medicare Durable Medical Equipment Access Act of 2007 (H.R. 1845, S. 1428)

These bills are critical in protecting beneficiaries and preserving the nation’s home care infrastructure, which is an important part of the answer to the looming Medicare and Medicaid crisis.

They would protect Medicare beneficiaries and small businesses that provide home care by amending several of the competitive bidding requirements for home care that were included in the Medicare Modernization Act of 2003. Some contracting provisions in the MMA could have the effect of restricting competition, reducing access to home care and hurting small providers.

The bills would:

• Exempt smaller, rural MSAs (populations under 500,000).
• Allow qualified providers that are small businesses and that submitted a bid below the current allowable to participate at the selected award price (S. 1428 limits this provision to providers whose annual revenues are $6 million or less).
• Restore the right of providers participating in the competitive bidding program to administrative and judicial review.
• Exempt items and services unless savings of at least 10 percent can be demonstrated, compared to the fee schedule in effect Jan. 1, 2006.
• Require CMS to conduct a comparability analysis for areas that are not competitively bid to ensure the rate is appropriate to costs and does not reduce access to care.
• Subject the CMS Program Advisory and Oversight Committee on competitive bidding to the Federal Advisory Committee Act, which requires public access to meetings and proceedings.
• Require that competitive bidding not be implemented until quality standards are in place.
• The House bill would require Congress to specifically re-authorize the program after the 10 initial sites before CMS could more broadly conduct competitive bidding.

Medicare Access to Complex Rehabilitation and Assistive Technology Act of 2007 (H.R. 2231)

Congress should pass H.R. 2231 so Medicare beneficiaries will continue to have access to high-quality products and services. This bill would carve out high-end power wheelchairs (and accessories) from competitive bidding.

• Complex rehab technologies are not commodity products that are easily interchangeable. Each consumer of the technology has individual, specialized needs requiring extensive customization.
• Competitive bidding fails to allow for the level of services and significant costs associated with the delivery of complex rehab technology to people with disabilities.
• Properly fitted equipment has a significant role not only in providing consumers with their greatest level of independence but also in preventing or delaying related medical complications, which can increase health care costs significantly.
• Significant savings will not be achieved by including complex rehab in competitive bidding. CMS has acknowledged that the complex rehab product category is “small,” and CMS’ data demonstrates that utilization of complex rehab products is low. An industry-commissioned study estimates the cost of the exemption over the first five years of the CB program to be $46 million.

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 [email protected].