WASHINGTON--Unable to settle on a Medicare package last week, the House of Representatives threw up its hands, tossing the hot potato to the Senate. The move could ultimately benefit HME providers, some Washington insiders said.
"What's promising is that the House has punted [the Medicare reform package] over to the Senate and said, 'You put it to together,'" said John Gallagher, vice president of government relations for Waterloo, Iowa-based VGM, noting that a Senate version of the legislation "would be more beneficial to the industry than what would be coming out of the House."
Whether the Senate can beat out a package that will be approved by both parties in Congress before legislators adjourn on Friday for the rest of the year--and whether it can craft one the president will sign--is uncertain. Senate Finance Committee Chairman Max Baucus, D-Mont., said last week it was possible that Medicare legislation "may be pushed off until next year."
Cara Bachenheimer, senior vice president, government relations, for Elyria, Ohio-based Invacare, said Friday "the fate of a Medicare package this year remains highly questionable."
But what happens is of crucial import to the HME industry.
For months, Congress has attempted to come up with a Medicare reform package including reauthorization and expansion of the State Children's Health Insurance Program. Under a "pay as you go" mandate, legislators also have been frantically searching for funds to avert a 10 percent reduction in physician fees set for Jan. 1. Among the suggested ways to pay for the so-called "doc fix": home oxygen and power wheelchair reimbursement cuts.
While President Bush vetoed the latest version of the SCHIP reauthorization bill on Wednesday, the threat to HME remains, Bachenheimer said.
"No question, oxygen and power wheelchair provisions are on the table, at risk," she said.
The House measure calls for the current oxygen rental cap to be reduced from 36 to 18 months (new technology would be exempt) and elimination of the first-month purchase option for power wheelchairs.
The Senate version is rumored to ditch the oxygen cap reduction and instead propose a reimbursement cut of anywhere from $30 to $70 for stationary oxygen concentrators (new technology would not be included in the cut). It would eliminate the first-month purchase option for power wheelchairs but would carve out complex rehab.
"In short, we now have a Medicare package from the House and an 'informal' Medicare package from the Senate," Bachenheimer said in an update from Washington. "The Senate package has not been publicized, has not been subject to Finance Committee approval, nor has it passed the Senate. These are unusual dynamics, making the House-Senate negotiation process fairly secret." She added that those negotiations could run through the weekend and into the early part of this week.
Bachenheimer also said that because of the brief period Congress has left before its Christmas recess, "the Medicare bill must be attached to a legislative vehicle that is a 'must-pass' piece of legislation or it is unlikely to move this calendar year."
Bachenheimer said the bill could be a part of a "small, one year or less, 'doc-fix' bill ... A six-month doc-fix bill is possible, punting the issue to next year's Congress to resolve."
Another stumbling block is the threat of a presidential veto. Earlier this month, President Bush told lawmakers he would veto any Medicare package employing managed care cuts or drug benefit cuts. Both the House and the Senate packages rely on cuts to managed-care programs as a means to finance their plans, Bachenheimer said.
"Therefore, even if the Congress passes a Medicare bill, it remains to be seen whether President Bush will veto it," she said.
Because nothing is yet set in concrete, both Bachenheimer and Gallagher stressed now is the time for HME providers to lobby legislators for no cuts to oxygen or power wheelchair reimbursement.
"We have got to get people fired up, on the phone with members of Congress and particularly members of the Senate," Gallagher said.
"We are working very diligently with our Senate allies to get oxygen and power wheelchairs off the list, or at least get the oxygen payment reduction decreased significantly," Bachenheimer said. "If the Medicare package doesn't happen before Congress recesses, it will come back early in 2008, and our fight will continue to ward off these proposed cuts."