Fall’s Busy Legislative Season

From Tom Ryan with AAHomecare:

There are just 99 days left on the calendar until January 1, 2016. On that day, CMS plans to unleash a double whammy on HME providers and patients through competitive-bidding derived rates for Complex Rehab accessories, as well as expanding the reach of prices from the bidding program to rural providers everywhere. Welcome to the brave new world of competitive bidding pricing, without actual bidding for the items covered!

A brief recap for any of you who might not be aware of these issues:

Rural Bidding Rates: In October 2014, CMS released a rule establishing a methodology for applying prices derived from the 100 competitive bidding areas to rural areas starting in January 2016 (although only half of the overall bidding-derived reduction will be applied at that time; the full weight of the cuts go into effect six months later). You can read more about it in AAHomecare’s issue brief here.

Bidding Rates for Complex Rehab: In November 2014, CMS released a rule that stating it will use competitive bidding pricing info obtained from bids for Standard wheelchair accessories to reduce the payment amounts for critical Complex Rehab wheelchair accessories, such as seat/back cushions, recline/tilt systems, specialty controls—all starting on Jan. 1. See more detail in AAHomecare’s related issue brief.

Needless to say, we’re not going to let CMS expand an already problematic bidding program—and especially not one that doesn’t at least give affected communities and segments the right to bid—without a fight.

On the Complex Rehab front, Congressman Lee Zeldin (R-N.Y.) has led the way by introducing H.R. 3229, which clarifies Congress’ intent to exempt all complex wheelchairs and accessories from the application of competitive bid rates. This legislation is also strongly supported by the National Coalition for Assistive & Rehab Technology, as well as a number of consumer and patient groups. If you supply Complex Rehab products or accessories, or if you’re appropriately appalled at another instance of CMS’ insistence on expanding the bidding program instead of applying common-sense fixes, we encourage you to contact your Congressional representatives and ask that they co-sponsor this legislation.

On the rural bidding issue, we’ve received reports that Congressman Tom Price’s (R-Ga.) plans to introduce legislation to lessen the effects of bidding-derived rates outside of the 100 metro areas covered in Round 1 and Round 2 of the program. Provisions of his proposal are expected to:

• Establish a 30 percent adjustment for rural suppliers to address their challenges serving widely spread communities;
• Provide a four year phase in for national price adjustments;
• Reinstate unadjusted fee schedule as bid cap, instead of CMS proposal for cap at previous bid rates; and,
• Provide for a demonstration project for a market pricing program approach, similar in approach to Congressman Price’s plan proposed in H.R. 1717 in the 113^th Congress.

Dr. Price is also working with Sen. John Thune (R-S.D.) to have companion legislation introduced in the Senate side.

Even though there is no specific legislation available at this time, we encourage providers outside of bidding areas to contact their representatives in the House and Senate to let them know what drastic price reductions that would come with the expansion of bidding-derived pricing will mean for your business, and for the patients you serve. You can also ask that they be on the lookout for legislation to address the issue soon.

While we’re focused today on dialing back CMS’ plans to expand the reach of the bidding program before January 1, I can also report that we’re also working hard to get new legislation introduced to address audit program over-reach and the burgeoning audit appeals backlog, and to expand the scope of prior authorization for HME beyond the current prior authorization demonstration for power mobility.

This Fall is shaping up to be an exceptionally busy season for AAHomecare and the HME community on Capitol Hill. I hope we can count on your passion and persistence in the weeks and months ahead as we work for stronger policies and better treatment for our industry.