WASHINGTON — Sen. Charles Grassley, R-Iowa, introduced a wide-ranging health care bill Tuesday that seeks to exempt rural areas from DMEPOS competitive bidding. Specifically, the measure applies to MSAs with a population of 600,000 or less. The provision is one of several initiatives outlined in the Medicare Rural Health Access Improvement Act of 2009, which Grassley said would also improve Medicare payments to rural doctors, ambulances and mid-size hospitals.
"The policy changes in this legislation go directly to the special challenges facing the health care system in rural America," Grassley said in a press release. "They recognize the high quality of health care delivered by rural providers, embrace common sense solutions and seek equitable treatment from payment systems."
Reaction to the proposal was varied. John Gallagher, vice president of government relations for the VGM Group, Waterloo, Iowa, believes the bill has little chance to become law. "I don't think it has a shot," said Gallagher. "The good thing is that Sen. Grassley understands that competitive bidding would be a nightmare for providers. What we need to ensure is that he understands that crazy competitive bidding bids will still eliminate rural providers with revised fee schedules based on the bid price."
Grassley has introduced similar measures in the past, according to Cara Bachenheimer. However, she believes the new administration could provide an opening for another bid delay. "We must do everything we can to suspend the bidding program, which means working with the new administration and with Congress," said Bachenheimer, senior vice president of government relations for Invacare, Elyria, Ohio. "Asking the new administration to suspend the rule could delay the program, but we are also working with Congress to develop support to further delay or suspend the bid program."
While the Grassley bill would not solve the HME industry's problem since it would not stop the bidding process, "the one plus is that it could help engender support from other rural members of Congress," noted another Washington insider. "Grassley has stature in the Senate, and other members of Congress may correctly infer that this bidding program decreases access to care in rural areas, and in urban areas, too."
As usual, the industry plate is full and extends well beyond competitive bidding. Bachenheimer pointed out that at least four key issues are high on the agenda for 2009. "First, fix the post 36-month payment issue," explained Bachenheimer. "Second, suspend the bid program. Third, restore the 9.5 percent cut for complex rehab. Finally, enact payment reform for home oxygen therapy so the statute explicitly recognizes and pays for the services providers routinely provide to beneficiaries."
After Congress delayed Round One of the Medicare bid in July, CMS issued an interim final rule on the program Jan. 16, in the waning hours of the Bush administration (see CMS Issues Interim Final Rule on Competitive Bidding, HomeCare Monday Special Alert, Jan. 15). But the rule, which carried an effective date of Feb. 15, is on hold pending the Obama administration's review.
Officials from the Accredited Medical Equipment Providers of America reported Thursday that during a recent Open Door Forum, CMS representatives said it is unclear when the new administration will lift the moratorium. "CMS admitted that they are running at half strength after the inauguration, with many political positions to be filled and many former officials resigning," AMEPA noted in a message to members.
VGM's Gallagher agreed the right move now is working to suspend and then eliminate the bidding program. "We need for [HHS Secretary-Designate Tom Daschle] to rescind the interim rule and for a champion to step forward to kill competitive bidding," he said. "It's bad policy that needs to be discarded."