HME Still Under Fire in Senate Health Bill

WASHINGTON — As expected, the Senate’s health care reform
bill contains a number of provisions that would directly affect
HME.

Released this week, the $849-billion bill — called the
Patient Protection and Affordable Care Act
— will be up for its first test tomorrow night (Nov. 21) when
the Senate is expected to vote on a motion to debate the measure.
If 60 senators (a filibuster-proof majority) vote in its favor, the
Senate would automatically adopt the motion. Floor debate would
then likely begin after Congress’ Thanksgiving recess.

A meld of the bills approved by the Senate Finance and Senate
Health, Education, Labor and Pensions committees, many of the
bill’s HME provisions are “substantially similar” to those
contained in the Finance Committee package released in September,
according to Invacare’s Cara Bachenheimer, senior vice president of
government relations.

Bachenheimer said the bill would:

• Expand Round 2 of competitive bidding by 21 MSAs
  (from 79) for a total of 100 in the program. It would also require
  HHS to bid all areas of the country or apply bid rates nationwide
  by 2016.

• Impose an annual $2 billion fee on medical device manufacturers
  according to market share. Beginning in 2010, the fee would raise
  $20 billion over 10 years. (The excise tax proposal in the Finance
  Committee bill was double the size, calling for $40 billion over 10
  years.)

  The fee would not apply to sales of Class I or Class II products
  sold at retail for not more than $100. Small manufacturers with
  sales of $5 million or less would be exempt, and firms with U.S.
  sales between $5 million and $25 million would pay the tax on 50
  percent of the sales.

  According to Bachenheimer, a similar provision in the House
  health reform bill would also raise $20 billion over 10 years “but
  takes a wholly different approach to imposing the tax.”

• Eliminate the first-month purchase option for standard power
  wheelchairs beginning in 2011. Payments would be front-loaded, with
  providers receiving 15 percent in months one through three and 6
  percent in months four through 13. Group 3 and higher PWCs would be
  exempt.

• Eliminate the 2 percent add-on payment (above CPI) for DME in
  2014 that Congress provided for in last year’s Medicare
  Improvements for Patients and Providers Act. Instead, a
  “productivity adjustment” would reduce fee schedule updates by
  approximately 1 percent each year.

• Exempt pharmacies with less than 5 percent of revenues from
  Medicare DMEPOS from the accreditation requirement until HHS
  develops pharmacy-specific standards.

• The bill does not include any specific provisions relating to
  oxygen.

View the entire text of S. 3590 (all 2,074 pages of
it).