WASHINGTON, D.C. (June 17, 2018)—On June 15, 2018, the Medicare Payment Advisory Commission (MedPAC) issued its annual report to Congress.
MedPAC is recommending that more products be included in the Medicare competitive bid program. There are three categories of products MedPAC believes should be included:
(1) Items that Congress has already authorized to be included (e.g., chest wall oscillation devices, ventilators and off-the shelf orthotics)
(2) Products that Congress has statutorily prohibited from including in the bid program (e.g., parenteral nutrition and bone growth stimulators)
(3) Items where MedPAC says it is unclear or additional legislative authority would be beneficial: ostomy, tracheostomy and urologicial supplies
MedPAC is also recommending that Congress “consider capping balance billing and reducing the allowed fee schedule amount by 5 percent for nonparticipating DMEPOS suppliers. The balance billing cap could be set equal to the physician fee schedule cap–115 percent–or somewhat higher (e.g., 125 percent–to the extent policymakers want to allow for added flexibility.”
MedPAC notes that nonparticipating suppliers have largely not exercised their ability to bill on a nonassigned basis: The “large pool of nonparticipating suppliers poses a risk to Medicare beneficiaries should these suppliers begin to balance bill in response to falling payment rates.” Such limitation would “mitigate that risk” and “better align DMEPOS policies with the rest of Medicare.”
The Medicare Payment Advisory Commission (MedPAC) is an independent congressional agency established by the Balanced Budget Act of 1997 to advise Congress on issues affecting the Medicare program. The Commission's statutory mandate is quite broad: In addition to advising the Congress on payments to private health plans participating in Medicare and providers in Medicare's traditional fee-for-service program, MedPAC is also tasked with analyzing access to care, quality of care and other issues affecting Medicare.
—Cara C. Bachenheimer of Brown & Fortunato for HomeCare