Getting Rid of the FEHBP-Based Cuts

The quintessential Washington wisdom this year is that of all election years — it will not be an active legislative season. So the HME industry must use this time to enlist political support for the objectives we have, both short-term and long-term. Although it appears all attention is focused on the presidential election, Congress is still charged with a number of must-do actions this year.

As an industry, we simply have too many issues on our plate to be politically complacent. Think of the sheer number of issues imposed on our industry by the Medicare Modernization Act (MMA). We cannot afford to sit on the sidelines.

In the short term, we are faced with reimbursement cuts for five categories of DME slated for January 2005 implementation. This provision of the law mandates that the Centers for Medicare and Medicaid Services cut Medicare reimbursement rates to be in line with rates that the Office of Inspector General has identified from certain Federal Employee Health Benefits Plans (FEHBP). The five DME categories are oxygen, standard manual and standard power wheelchairs (K0001 and K0011), nebulizers, air mattresses and diabetic supplies (lancets and strips).

Should we sit around and watch the cuts happen? You know the answer. This MMA provision was ill-founded and should be repealed.

This month, everyone in the industry must write their members of Congress. (You can find their contact information by visiting http://thomas.loc.gov, scrolling to the bottom and clicking “contact us.”) Use the points below in your letters, and, at the end of each, be sure to ask your senators and representatives to support the repeal of this offensive provision.

1. Background: The 2003 Medicare Modernization Act contains a provision to make reimbursement cuts to five categories of DME based upon Federal Employee Health Benefits Plans (Section 302(c)(2)). These payment cuts should be repealed for four reasons.
2. The data used to identify FEHBP pricing was scanty at best, even by the OIG’s admission. In a June 2002 letter to Sen. Tom Harkin, the OIG stated that the data used to identify FEHBP pricing was insufficient for an “inherent reasonableness” reduction. Bad data makes bad policy.
3. The provision was inserted in the Medicare bill at the eleventh hour, providing members of Congress no opportunity for consideration or debate about the merits or deficiencies of the proposal.
4. FEHBP coverage and payment policies are simply not comparable with the Medicare program. FEHBP plans often cover and pay for DME differently than Medicare. FEHBP plans may cover and pay for related functions and services separately from items of DME, while Medicare bundles such functions and services together with items of DME. Simply looking at the prices for DME in this context is misleading at best.
5. Suppliers’ costs of doing business with the FEHBP plans are significantly less than their costs in dealing with Medicare, and that difference would not be reflected in a simple comparison of payment levels.
6. Closing paragraph (and this is especially important to include): “We ask for your support in repealing this provision that was ill-founded and is simply bad policy.”

Two weeks after mailing or faxing your letters, follow up by calling your representatives’ and senators’ offices. Ask if they support repealing this bad policy and if they need additional information. Most importantly, close the sale and ask for their commitment. If you cannot obtain a commitment, ask why. If they do support repealing the policy, send me an e-mail and contact the American Association for Homecare (www.aahomecare.org) with that important information.

Grassroots lobbying does work. But for it to work, we must all be actively engaged in the activity. Don’t delay. Write your letters today.

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].