Bills Affecting HME Are Multiplying on Capitol Hill

ATLANTA — If you think H.R. 1041, the bill that would
repeal competitive
bidding, is the only HME game on Capitol Hill, here is some
news: There is plenty of other legislation that could potentially
affect your home medical equipment business. And there’s wanna-be
legislation as well.

Here’s a snapshot of some bills, both introduced and in the
works, that could change the way you do business. Each is currently
under review by one or more committees.

S. 1273, the Direct Care Job Quality Improvement Act

Introduced June 24 by Sens. Tom Harkin, D-Iowa, and Robert
Casey, D-Pa., the bill would “ensure direct care workers, who often
care for seniors in their homes, receive minimum wage and overtime
pay.” The legislation would also establish a monitoring program to
oversee the capacity and quality of the direct care work force and
establish a grant program aimed at helping states improve
recruitment, retention and training of direct care workers.

S. 1203/H.R. 1295, the Medicare Home Infusion Therapy Coverage
Act

Designed to close a gap in coverage where medications used in
home infusion to treat an array of serious diseases are covered but
the medical equipment and services that go with them are not, the
companion bills were introduced June 15 by Sens. Olympia Snowe,
R-Maine, and John Kerry, D-Mass.; and Reps. Eliot Engel, D-N.Y.,
and Tim Murphy, R-Pa. The legislation calls for infusion-related
services, supplies and equipment for home
infusion therapy to be covered under Medicare Part B, while
coverage of the drugs would remain under Part D.

S. 1217/H.R. 2233, the Breast Cancer Patient Equity Act of
2011

Similar to legislation introduced in 2010, this bill was
introduced June 16 by Sen. Olympia Snowe, R-Maine, and Rep. Mike
Ross, D-Ark., and proposes coverage for custom breast forms,
currently the only custom prosthesis not covered by Medicare. While
Medicare recognizes custom breast prostheses as a valid treatment
option — and has assigned a billing code — the program
now denies claims as “not medically necessary.” Medicare does
provide reimbursement, however, for more costly surgical breast
reconstruction.

H.R. 436/ S. 17, the Protect Medical Innovation Act

Companion bills that would repeal the medical
device tax included in the Patient Protection and Affordable
Care Act were introduced Jan. 25 by Rep. Erik Paulsen, R-Minn., and
Sen. Orrin Hatch, R-Utah. The tax is set to be implemented in 2013
and is estimated to raise $20 billion over 10 years. As of
Wednesday, the House bill had 163 cosponsors, the Senate bill
17.

H.R. 452, the Medicare Decisions Accountability Act

In an attempt to repeal a provision in the health reform law
that created an Independent Payment Advisory Board for Medicare and
gave it the power to cut reimbursement, Rep. Phil Roe, R-Tenn., a
physician, introduced H.R. 452 on Jan. 26. The bill has so far
garnered 144 cosponsors. Last week, more than 270 health care and
business organizations sent a letter to Congress urging
elimination of the board.

S. 1251, the Fraud and Abuse to Save Taxpayer Dollars Act (or
FAST Act)

Introduced June 22 by Sens. Thomas Carper, D-Del., and Tom
Coburn, R-Okla., this legislation could require prepayment review
for a wide range of HME as an anti-fraud measure. According to its
text, the bill would require procedures for “prepayment review,
which may include pre-certification, for all claims for
reimbursement under this title for durable medical equipment at
high risk of waste, fraud, and abuse, as determined by the
Secretary, including power wheelchairs.”

Future Legislation

Even as those bills maneuver their way through the legislative
process, others are working their way toward becoming bills.

On Tuesday, Sens. Tom Coburn, R-Okla., and Joseph Lieberman,
I-Conn., released a plan to overhaul Medicare. The main points of
the plan: gradually raise the eligibility age to 67 from 65; have a
single deductible for both Part A and Part B Medicare of $550;
establish a maximum out-of-pocket limit ($7,500) for all enrollees;
accelerate the reimbursement changes for home health providers
under the Affordable Care Act to save $9 billion over 10 years;
require higher-income enrollees to pay more for Medicare and for
their share of Medicare Part B and Part D; increase the minimum
premium to 35 percent of the program’s cost for enrollees. So far,
the plan has generated no support from Democrats.

Meanwhile, the effort to gain a separate Medicare benefit for
complex rehab technology continues. The National Coalition for
Assistive and Rehab Technology and the National Registry of
Rehabilitation Technology Suppliers have draft legislation, a
position paper and a proposal for the benefit and continue the hunt
for a legislator to carry the bill. Toward that end, the ITEM
Coalition, the Consortium for Citizens with Disabilities Health
Task Force and the Coalition to Preserve Rehabilitation sponsored a
congressional briefing on June 23 to spotlight the value of rehab
services and devices. At the briefing, Don Clayback, NCART
executive director, distributed information on the separate benefit
initiative.

And in the newest effort that could dramatically affect HME,
Rep. Pete Stark, D-Calif., prompted by a new GAO report, said
Wednesday he has asked the Center for Medicare and Medicaid
Innovation to look into testing a competitive bidding program for
manufacturers of HME. The report, “Medicare: Issues for
Manufacturer-Level Competitive Bidding for Durable Medical
Equipment,” analyzes such programs for manufacturers of oxygen
equipment, wheelchairs and walkers and says that Medicare could
realize significant savings through competitive bidding.

Stay tuned.