hands holding bid paddles
Raise the bar for local care
by John E. Gallagher

Now is the time for providers and durable medical equipment (DME) state associations to begin focusing on their individual state’s licensure procedures—or lack thereof. Why? Requiring DME licensure within states will create safeguards for the industry and allow providers to raise the bar for local care.

We are in a period where there is some uncertainty as to when the next round of competitive bidding will be and exactly what will be bid as it relates to product categories. Mark Higley, VGM vice president of regulatory affairs, believes that the Centers for Medicare & Medicaid Services (CMS) would be hard pressed to implement the next round of the competitive bidding program (CBP) sooner than January 2024. That gives the DME industry time to prepare for and implement individual state licensure during the 2023 state legislative session. The industry has had success with state licensure in such states as Alabama, Kentucky and Tennessee.

Beyond helping create safeguards for the industry, DME licensure will also help:

  • Protect your business with minimal requirements
  • Make it difficult for out-of-state providers to take your business
  • Promote credibility and transparency in the DME industry and show that DME companies are the “good guys”
  • Fight competitive bidding because regulations won’t let an out-of-state provider supply DME without following that state’s regulations
  • Give DME a spot at the policy table

Protect Your Business

Simply put, DME state licensure helps level the playing field. It holds out-of-state providers to the same quality standards that you and your local competitors are held to. Right now, in the competitive bidding program, the advantage goes to those out of state that would simply like to drop ship CBP product categories to beneficiaries. State licensure holds all who wish to bid in a certain competitive bidding area (with state DME licensure) to the same standards. That is something we should all support.

State licensure protects providers from out-of-state bidders with low-ball bids that take business simply because they are not held to the same standard as local providers by the referral source. Requiring state licensure doesn’t mean a provider can’t supply services or products for beneficiaries in adjoining states or across state lines, but it does mean that provider’s proximity to the patient or beneficiary—and ability to respond in a timely fashion when there is need for services or set up—are important.

Promoting credibility and transparency in the DME industry is key to advancing the effort of state DME licensure. State providers working with their state legislators are not asking for a barrier to be set up against out-of-state competitors or to restrict trade. Providers are looking to make sure beneficiaries in the state have access to receive quality care when they need it most. When explained in this way to state legislators, they see local DME providers in a different light—as the “good guys.”

Transparency is key. Holding all providers, regardless of location, to the same standards ensures access to quality care.

Local Care Is the Best Care

Fighting the competitive bidding program is perhaps one of the best parts of a state DME licensure effort. Even CMS knows that the CBP is flawed. Allowing out-of-state providers to win bids based on a different set of standards only ensures the eventual breakdown of access to quality products and essential care. When there is an ice storm in the Upper Midwest or hurricane in the Southeast that disrupts power, what happens to the beneficiary? With the CBP, they are left on their own or told by an out-of-state provider to go to the emergency room. Is that what we want in our local communities?

Most state legislators understand that the best care is local care. Local providers employ local people and pay local and state taxes that benefit local school districts. Local providers also engage with their communities and promote local youth sports, senior centers and other charitable ventures. Licensure is not restrictive. Exemptions are allowed for certain products or product categories when it makes sense—diabetic supplies, for example. Certain providers could be exempt as well, such as a pharmacist who already has licensure in place. The bottom line, once again, is that DME state licensure levels the playing field and holds all providers to the same standards and procedures.

Finally, DME state licensure allows state associations and providers to have a seat at the policy table to work on the standards that all providers in that state should be held to. This helps ensure access to and quality of the products and services that beneficiaries receive. This will only enhance and elevate the industry in the eyes of our referral sources and that of state legislators as well.

If Mark Higley is correct and CMS will indeed be hard pressed to implement the next round of the CBP sooner than January 2024, the DME industry has time to prepare for and implement individual state licensure during the 2023 state legislative session. Reach out to your state association and offer to assist in working with your state representative and state senator to implement sound DME state licensure and ensure your state beneficiaries have access to quality products and care.

John E. Gallagher is vice president of government relations for the VGM Group, Inc. in Waterloo, Iowa, the largest organization representing independent durable medical equipment (DME) providers. In his position, Gallagher oversees key government and regulatory affairs that pertain to the DME industry. Gallagher has amassed thousands of miles traveling across the country to educate both state associations and independent providers on regulatory and government issues. He has also worked to promote the DME industry while advocating for beneficiaries’ access to quality care. Visit vgm.com.