WASHINGTON, D.C. (December 8, 2015)—House legislation to address CMS’ plans to apply bidding-derived pricing outside of competitive bidding areas (starting January 1, 2016) has been introduced today by Reps. Tom Price (R-Ga.) and Tammy Duckworth (D-Ill.) The new bill, HR 4185, the Protecting Access through Competitive-pricing Transition (PACT) Act, includes provisions that:

  • Apply a 30% positive adjustment to single payment amounts (SPA) (calculated on a regional basis) for suppliers in non-bid areas.
  • Provide a two-year phase-in period for bidding derived pricing for non-bid areas.
  • Set the ceiling for future bidding rounds of the competitive bidding program at the unadjusted fee schedule rates in effect on January 1, 2015, instead of CMS’ proposal to set a bid ceiling at the previous bid amount rates. This is an important component of the legislation that will benefit all providers subject to competitive bidding rates in future bidding rounds.
  • Instruct CMS to revisit pricing adjustments for non-bid areas that takes into account travel distance, clearing price and other associated costs for furnishing this equipment for prices that will be in effect on January 1, 2019.
  • Implement a Market Pricing Program demonstration project to compare an alternative methodology for achieving sustainable savings while preserving access to medically necessary equipment, supplies, and services to beneficiaries.  The ten site demo will include the same DME items as the Competitive Bidding program, require binding bids, weigh historic capacity of bidders, and determine price based on the clearing price. A separate auction will occur in two states for diabetes testing supplies.

The new legislation is a companion bill to S 2312, which was introduced in the Senate in November. Staffers for Rep. Price and Sen. Thune worked closely to get similar provisions in both bills, and will have additional chances to take part in negotiations on final legislative language as these bills are considered as part of omnibus budget reconciliation legislation expected this week.

AAHomecare applauds Reps. Price and Duckworth for their leadership in driving this legislation that recognizes the additional challenges and expense associated with serving patients in rural and less-populated geographical areas.

Additional co-sponsors at introduction included Reps. Marsha Blackburn (R-Tenn.), David Loebsack (D-Iowa), Rep. Tim Ryan, (D-Ohio), Cathy McMorris Rodgers (R-Wash.), Kristi Noem (R-S.D.), Peter King (R-N.Y.), Ryan Zinke (R-Mont.), Phil Roe (R-Tenn.), Tom McClintock (R-Ca.), Rod Blum (R-Iowa), and Scott Tipton (R-Colo.).

Find the full text of the bill here. Visit aahomecare.org for more information.