HME Leaders Push for Price Relief & More

ATLANTA (October 27, 2022)—The home medical equipment (HME) industry faces a wide range of questions as 2022 winds down, experts said at the latest Medtrade East expo and conference this week—including whether providers will get any relief from rising prices, what the November election will bring and which COVID-19-related waivers will continue and for how long.

“Today, providers are stressed and we’re seeing more and more challenges and it’s not gotten any better,” Tom Ryan, president and CEO of the American Association for Homecare (AAHomeCare), said Tuesday in an address to attendees at the show Atlanta. “We’ve tried to go to (the Centers for Medicare & Medicaid Services, or CMS) and align the rates to something more reasonable and that hasn’t worked.”

One lingering issue is whether the competitive bidding program, which some have placed on death watch, will be revived or not. Most experts at the event said that CMS had already missed most of its historical deadlines to institute competitive bidding next year—but that it’s time for them to make a decision so providers don’t have to keep reading tea leaves.

“It is not sufficient, it has not kept up with the time and the reality is it’s got to be fixed,” Ryan said. “We do need some security that we don’t have a competitive bidding program coming in a couple of years.”

“I can’t wait until we come to a Medtrade and we don’t talk about competitive bidding,” added Kim Brummett, AAHomeCare’s vice president of regulatory affairs, who said that regulators just don’t seem to have it at the top of their priority list right now. And yet, Ryan said, it should be.

“The labor shortages are not getting any easier, (personal protective equipment) costs are expensive and we have seen routine double-digit price increases, which we have not seen in years, and we’re still seeing old reimbursement rates,” he said.

Watching Washington
When it comes to change on the Hill, Jay Whittier, AAHomecare’s vice president of legislative affairs, said there are three main focuses for the industry. The first, HR 6641, would provide a blended rate based 90% on competitive bidding rates and 10% on the unadjusted 2015 fee schedule in competitive bidding areas through 2024. Whittier said the industry is actively seeking it in the end-of-year package.

Second, advocates are pushing the Senate to extend relief granted in the CARES Act past the end of the public health emergency, especially a 75%-25% formula for non-rural areas that are also non-competitive bidding areas.  

“As we all know, the cost issues the challenge of labor and fuel, are not going tend when the public health emergency ends,” Whittier said.

Third is the “PAYGO,” or pay-as-you-go rule that has triggered mandatory cuts to Medicare and other payments. If unabated, the PAYGO cuts could tally 4% on top of 2% sequestration. As to whether it will be corrected, Whittier said he’s not counting on anything these days, even though Congress has always diverted these cuts in time in the past.

“Well, we’ve had a lot of firsts,” he said, spurring laughter from the crowd. “I’m not going to rely on any precedent in the environment we’re in.”

When it comes to the end of the public health emergency (PHE), Brummett and Cara Bachenheimer, head of government affairs at Brown and Fortunato, said in a separate session that it may be extended to the spring of 2023. It currently ends January 11, but the administration has pledged to give states at least 60 days of notice before ending it—meaning they’d need to make a change by mid-November.

Other concerns include:

• Medicare Advantage: “It has kind of been the Wild West,” Ryan said, and MA programs are exected to continue to grow, with a projection of 61% of Medicare beneficiaries being in them by xx. Some help would come with HR 3173, the Improving Seniors’ Timely Access to Care Act, which would fast track prior authorization. Advocates have also asked CMS to add an MA ombudsperson or other additional oversight of MA.
• Audits: Some audits are back on track even while the pandemic continues—in fact, 43 of 41 of the total active audits listed on the Recovery Audits Contract website are DME-related—and Brummet and tktk Cara Bachenheimer separately reminded attendees of special rules that apply. They also said they’ve pushed CMS to ensure providers don’t have to endure multiple types of audits simultaneously.
• Consumer Price Index: These adjustments are expected in December, and could be close to 9% in some categories. Ryan said that’s sort of a bad news/good news scenario: “It will be a good year in a bad year—it will be a higher rate than we’ve had before, but it will be because of inflation,” he said.
• Explaining the Importance of HME: At the show, AAHomecare shared a new brochure called “The Value of HME” that it’s encouraging providers to access and to share with their local leaders. Find it here: https://issuu.com/experience-moxie/docs/22_553404_aahomecare_value_of_hme_brochure?fr=sYzkzYTUzNzg0NjI