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.