AAHomecare Meets with CMS to Discuss Reimbursement Policy
WASHINGTON, DC – AAHomecare senior staff met with CMS leaders last week for an update on the Agency’s plans for future bidding rounds and to make the case for HME reimbursement policy priorities. Jason Bennett, acting director of CMS’ Technology, Coding, and Pricing Group, led the CMS delegation on the productive Zoom session.
Our key takeaway from the meeting was the inference that CMS does not plan substantial rulemaking on HME this year that would set a new competitive bidding round in motion. While the prospect of continuing open access to HME products in former CBAs should cheer suppliers, patients, and clinicians alike, reimbursement rates based on bids from seven years ago continue to hamper our industry.
AAHomecare stressed the need for a meaningful adjustment for reimbursement rates that reflect the market realities that suppliers are facing in the wake of both broad-based inflation as well as increased product and operational costs specific to healthcare providers and HME in particular. To illuminate that case, AAHomecare shared a timeline on former CBA reimbursement history and changing costs since the last completed and implemented bidding round in 2015. AAHomecare also advocated for extending the 75/25 blend for non-rural, non-CBA suppliers beyond the end of the PHE.
In addition, we asked CMS to help ensure that audits on claims filed during the PHE do not trigger improper denials based on the wide range of waivers in place during that period. We also specifically requested CMS allow for patients that received a continuous glucose monitor during the PHE to continue to receive related supplies post-PHE, as many of the individuals who qualified under the waivers during the pandemic will not qualify when the PHE finally ends.
Our CMS counterparts appear to understand and appreciate the challenges that the HME community is facing. Even so, we must continue to engage Capitol Hill on our Medicare reimbursement priorities in the hopes of securing substantial relief at the legislative level, or to generate Congressional pressure on CMS on these issues. Strong participation in next month’s Virtual Washington Legislative Conference will increase our chances of success on these fronts.
AAHomecare Introduces Diabeties Council
WASHINGTON, DC – In October, AAHomecare will host the first meeting of its newly formed Diabetes Council in Arlington, VA for key leaders in the diabetes market. The Board of Directors voted in July to establish this new Council to meet the needs of member providers in this space.
According to the CDC, the pervasiveness of type 1 and type 2 diabetes will increase by 54% to more than 54.9 million Americans between 2015 and 2030. As the need for diabetes devices grows, so does the need to establish a cohesive group of diabetes supplies providers to strategize, advocate, and communicate the challenges of the market.
The new Council will be Chaired by Linda Langiotti of CCS Medical, and John Pryor of AdaptHealth will be Vice Chair. Together with Council input, they will lead the discussion to develop Council goals for 2022-2023, which include:
1) demonstrating the benefits of the DME channel for access and compliance to diabetes device therapy;
2) ensuring distributors have a voice in policy making for DME coding & coverage criteria;
3) developing strategy for continuing to treat patients on CGM therapy when the PHE comes to an end; and
4) addressing taxability of CGM devices on a state-by-state basis.
AAHomecare staff will assist with policy and commercial payer opportunities and provide guidance during Council meetings. “The AAHomecare team has established a successful model to deliver measurable results through our Councils, and we are already familiar with the issues surrounding continuous glucose monitors and the diabetic market,” notes Tom Ryan, president. “Diabetes companies joining this Council will find passionate support, devoted assets, clear goals, and tangible results. We’re confident that there is a natural fit for this coalition within our framework.”
The Diabetes Council will be a closed Council comprised of AAHomecare Corporate Partners in the diabetic space to ensure a nimble and effective group. The Council is poised to make a broad impact for the diabetes industry, and we are honored to support this important market segment of the HME community. Please reach out to Tilly Gambill, firstname.lastname@example.org, for further information.
22 House Members Ask CMS to Streamline Documentation for Oxygen
WASHINGTON, DC – Twenty-two members of the House of Representatives have asked CMS to ensure that medical documentation requirements do not unnecessarily restrict patient access to oxygen at home. The sign-on letter spearheaded by Reps Terri Sewell (D—AL) and Larry Bucshon (R—IN) specifically requests that CMS:
“Use the opportunity of expanding the current National Coverage Determination for oxygen to establish a clear set of criteria to support medical necessity and instruct the contractors to rely solely on the Standard Written Order as they are doing during the pandemic or to include with that order a completed template to support medical necessity without having to review individual clinician’s medical records.”
The CQRC deserves credit for leading the effort to develop the letter with Reps. Sewell and Bucshon. Thanks to the HME advocates who asked their House members to add their names, as well our partners at state and regional HME associations who helped raise the visibility of the sign-on letter.