Offense and Defense

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 [email protected].