ATLANTA — An amendment suggesting a pay-for for H.R. 2373, the bill that would repeal the 36-month oxygen cap, could be announced soon, a move that is expected to give the bill the gas to go forward, stakeholders said last week.
The Home Oxygen Patient Protection Act, introduced in May 2009 by Reps. Tom Price, R-Ga., and Heath Shuler, D-N.C., has stalled for months as providers and organizations split on the bill and legislators asked the hard question: How would the industry pay for the repeal in Congress' budget-neutral world?
"We have had conversations with Price's office to see if he would be open to amending the legislation, and he is willing to do that," said Todd Tyson, president of Norcross, Ga.-based HiTech Healthcare and president of the Georgia Association of Medical Equipment Services. "We have reached out to Shuler's office, and they are likewise willing to consider a fiscally responsible pay-for if we repeal the cap.
"Within the next 30 days," Tyson added, "the stakeholders will have a conversation and we will have a pay-for."
The cap is mandated under the Deficit Reduction Act of 2005, which calls for CMS to cap reimbursement for home oxygen at 36 months. After that period, providers no longer receive rental payments for equipment and get only minimal payments for service, which they are required to provide for another two years.
CMS implemented the cap on Jan. 1, 2009. Since then, some oxygen providers have gone out of business and others have refused to accept new patients, particularly those within a year or less of capping out.
Frantic to save their businesses and aid desperate beneficiaries, stakeholder factions began trying to craft potential legislation that would repeal the cap. Months of bitter disagreements ensued before one plan emerged that Price and Shuler agreed to carry. The industry remained divided, however, until recent weeks when stakeholders managed in large part to agree on the bill. In late February, the American Association for Homecare, which had withheld its support, released an issue paper calling on Congress to enact H.R. 2373.
"The association supports the HOPP Act along with the addition of key improvements to the home oxygen benefit, including linking reimbursement to beneficiary need and patient protections, while sparing oxygen patients from further reductions," the organization stated.
"We still have differences of opinion, but I don't see an industry split," said Wayne Stanfield, president of the National Association of Independent Medical Equipment Suppliers. "There will certainly be some people who will not support this. But I don't see it as divisive as it was before. I think 99 percent of the plan that we want is there."
Tyson said most stakeholders agree on at least two major points. "We all agree that the cap is bad and that there are a lot of issues with patient safety. We see companies that just quit. Those patients have been orphaned and abandoned."
Beth Bowen, executive director of the North Carolina Association of Medical Equipment Services, said she is increasingly hearing stories of patients who are not able to get oxygen service.
"Our industry needs to get rid of the cap," she said. "Patients are having too much difficulty getting providers to take care of them, especially when they relocate. And some patients have to relocate, whether it is for health or their family is moving. They don't have a choice. It is unfortunate that the way the law is written now, they're having difficulty getting service."
Bowen said H.R. 2373 needs to move forward as soon as possible.
"The urgency is now," she said, noting that at AAHomecare's Legislative Conference in Washington last week, she and numerous others lobbied not only for H.R. 3790 to eliminate competitive bidding but also for H.R. 2373.
As of Friday, H.R. 2373 had 83 cosponsors. Stanfield, Tyson and Bowen all said they expected that number to grow in the coming weeks.
"We will be fiscally responsible and we will have a pay-for," said Tyson. "We're not here with our hands out." He added that stakeholders hope to get H.R. 2373 passed this year. Toward that end, he said, Price and Shuler will soon send a "Dear Colleague" letter to their peers on Capitol Hill asking for support.
Both Price and Shuler have said they would reintroduce the proposed legislation next year if it doesn't make it this time, Tyson said, but stakeholders would have to start all over again lobbying for repeal of the oxygen cap.