When Will We See Better Regulatory Environment for HME?

The operating environment for home medical equipment providers who depend on Medicare reimbursement (as well as the wide range of payers who peg their rates to the Medicare fee schedule) remains exceptionally challenging.

I continue to hear from or read about HME companies who are reducing their offerings, no longer accepting assignment, or going out of business altogether. These reports are always dispiriting, but they are not surprising given how companies serving rural communities have been saddled with Medicare reimbursement cuts of 50 percent or more across almost every product category.

Despite these dire circumstances, I’m convinced the business and regulatory climate for this industry is on its way to changing for the better. Relief may not arrive soon enough for providers who are barely hanging on or having to cut employees, which frustrates me a great deal. But I truly believe we’re positioned to get some wins that will help providers in the near future and also provide for some long-term fixes for the bidding program, thanks to both the continued public policy engagement of HME stakeholders, as well as new leadership at key regulatory agencies.

An Army of 150 Hits Capitol Hill

I’m always proud to see so many providers and manufacturers come from across the country to take our industry’s case directly to members of Congress and their staff at AAHomecare’s annual Washington Legislative Conference. Thanks to the efforts of this group, we were able to increase the number of scheduled Hill appointments to 261 at this year’s recently-concluded conference—a 13 percent increase over 2016.

One of our primary “asks” on Capitol Hill this year was for House members to join a sign-on letter to HHS Secretary Price and CMS Administrator Verma, asking them to use their authority to make significant changes to HME policy in four key areas. The letter, which ultimately garnered signatures from more than one-third of the House (154 signees), echoes earlier input from AAHomecare and other stakeholders to the agencies and specifically asks CMS for action in these areas:

Relief for providers in non-competitive bid areas; structural reforms for the competitive bidding program; relief for Complex Rehab Technology accessories; and rolling back recent additional oxygen concentrator reimbursement cuts in rural areas.

It’s worthwhile to keep in mind that relief for non-bid-area providers would also have a positive effect on reimbursements for TRICARE and other payers who base their rates on that fee schedule, ultimately benefiting providers everywhere.

While we’re aggressively engaging HHS and CMS to make the case for action in these areas (I’ll get into more specifics on that), it remains important to keep Congress informed and involved on our priority issues. Next year’s conference will again take place in late May. Visit aahomecare.org or our Twitter or Facebook feeds for updates.

HHS and CMS: A Promising Start

The home medical equipment community buzzed with anticipation when Dr. Tom Price, perhaps the most engaged and well-informed member of Congress when it comes to HME issues in recent years, was nominated and confirmed as Secretary of Health and Human Services. It’s not hard to get carried away with optimism at the prospect of having a leading proponent of fixing the competitive bidding program and fair reimbursement rates for rural HME providers at the head of the agency overseeing the Medicare program.

While HME stakeholders should remain excited about the prospects of meaningful regulatory gains for our industry, we must remember that the federal regulatory process is not a fast-moving animal, but rather a deliberate one. While that truth is frustrating in light of the number of HME providers operating at narrow or even negative margins, it’s important to remember that if we do ultimately get regulatory improvements to the bidding program or more sustainable reimbursement rates for rural providers, these gains are not likely to be undone quickly.

In addition, the team is still coming together at HHS and CMS. Secretary Price was confirmed in mid-February, and CMS Administrator Seema Verma was confirmed a month later; key staff positions at these agencies are still being filled.

Our approach in working with regulatory agencies remains built on these principles: to make sure that we remain a credible and reliable representative of the HME community and the patients we serve; to make our case as effectively as possible, to work in concert with other HME industry and patient groups to coordinate our efforts; and, as noted, to keep Congress engaged in communicating their support for our policy priorities.

Strong Commitment in the Face of Challenges

Despite the deep cuts for many segments of our industry from Medicare and payers who operate using those rates as a guideline, the commitment of providers to remain strongly engaged in advocacy efforts, as strong industry support for AAHomecare through both dues dollars and growing participation in our various policymaking councils, gives me great hope for the future. Our membership continues to grow overall, even in this difficult time for many providers, and we’re putting the resources they provide to good use. For example, our growing membership has allowed us to contract with a highly experienced and respected legal counsel with CMS experience, who has been a tremendous resource in our recent outreach to the Agency.

I hear the concerns from providers everywhere—and especially those serving rural communities—who are frustrated that we haven’t seen results yet. I’m confident these efforts are going to pay real dividends for HME providers, but the question remains: When will that happen?

Until we get that answer, you can be assured we’ll continue to do everything we can to work directly with regulators, to marshal the grassroots capabilities of our state and regional association allies and to keep building strong relationships on Capitol Hill to deliver better public policy and an improved business environment for the home medical equipment community. I take great strength from knowing that so many of you remain committed to helping us get there.