AAHomecare Sets Ambitious 2023 Federal Policy Agenda

WASHINGTON, D.C. – As reported in late December, end-of-year Omnibus legislation included provisions sought by the HME community, such as ensuring that the 75/25 blended rate for non-CBA/non-rural suppliers remained in effect until the end of 2023 in the event that the COVID-19 PHE ends before that time.

In addition, AAHomecare and other healthcare providers were successful in preventing across-the-board 4% Medicare PAYGO cuts for at least two more years. The Omnibus package also included a two-year extension for telehealth waivers established during the COVID-19 PHE.

While HME advocates can be proud of persistent advocacy efforts that resulted in tangible, substantial relief that will pay off in 2023, AAHomecare leadership is already working to build on these wins in the 118th Congress, as well as through engagement with CMS and the Administration. This week, the Association’s Executive Committee approved these Federal policy priorities for 2023:

1. Further extending (or making permanent) 75/25 blended non-rural, non-CBA Medicare reimbursement rates. These rates influence other payers who peg reimbursements based on these rates, including Medicaid rates in 21 states as well as TRICARE rates.
2. Continue to advocate for 90/10 blended Medicare rates in CBAs; introduce House and Senate legislation.
3. Work with Congress to encourage CMS to provide clarity on their plans for the Competitive Bidding (CB) program. If CMS indicates it plans to move forward, we will work with Congress on legislation that would codify into law important guardrails that are currently in place, including clearing price methodology and using the unadjusted fee schedule as bid ceiling. If the CB moves forward, we will to work with Congress to require CMS to accept higher rates if that is the result of the bidding process.
4. Maintaining coverage for oxygen and continuous glucose monitor (CGM) patients granted under relaxed PHE requirements beyond the end of the PHE.
5. Work with Congress on oversight and transparency of Medicare Advantage plans to ensure Medicare beneficiaries have to the same access to care as in Part B.
6. Work with Congress and industry stakeholders on legislation to establish oxygen criteria via critical data elements (CDE).
7. Work with CMS and Congress to prevent competitive bidding program from expanding to include CGM, ostomy, and urological products.
8. Work with Congress on legislation to include titanium/carbon fiber upgrades for mobility products as a Medicare benefit.
9. Monitor Federal legislation on “right to repair” issues and potential impacts on mobility providers, manufacturers, and patients.

Delivering on such an ambitious Federal policy agenda will require the continued investment of veteran HME advocacy leaders, as well as educating and mobilizing more HME stakeholders and allies to add their voice to our efforts to deliver better policies for our industry. The AAHomecare team looks forward to working with you to bring home more wins for HME in 2023 and beyond.

New Modifiers and Other Updates From Oxygen LCD that Suppliers Should Note

WASHINGTON, D.C. – Due to updated Oxygen and Oxygen Equipment Local Coverage Determination (LCD L33797) that went into effect January 1, 2023, there are several changes oxygen suppliers should be aware of. CMS is no longer requiring Certificate of Medical Necessity (CMN).

This removal is effective for claims with a date of service beginning January 1, 2023. Suppliers that continue to submit their oxygen claims with CMN will be frontend rejected. DME MACs published Correct Coding – Submitting Oxygen Claims with Modifiers KX, GA, GY, and GZ – Revised, reminding suppliers of the use of the new modifiers indicating whether a beneficiary meets the reasonable and necessary coverage requirement. Claim lines that are submitted without a KX, GA, GY, or GZ modifier will be frontend rejected.

COVID-19 PHE Extended into April 2023

WASHINGTON, D.C. – HHS Secretary Xavier Becerra today extended the COVID-19 Public Health Emergency (PHE) for an additional 90-day period, through April 11, 2023.

As long as the PHE continues, the 75/25 blended rate in non-rural/non-CB areas will remain in effect, along with other policies tied to the status of the PHE, including:

• NCD/LCD flexibility allowing expanded use of home-based respiratory products and continuous glucose monitors.
• Waiver of face-to-face requirements for many products; allows the use of telehealth for items that are not included in the waiver such as PMD.
• 2% increase in Medicaid FMAP match (will remain in effect through the end of the quarter the PHE expires).
• TRICARE reimbursement increases tied to the Medicare rate relief.

HHS Secretary Xavier Becerra has provided guidance to healthcare stakeholders that the Agency will provide at least 60 days’ advance notice before ending the PHE.

New Advocacy Resources Address Order Process

ARLINGTON, VA – The HME/RT Council developed a series of DME order flowcharts to help payers and governmental bodies better understand the intricacies involved in providing DME and the role of suppliers in the care continuum. The flowcharts provide a visual guide to educate payers on the provision of home oxygen therapy, RAD and PAP, ventilators, and standard DME.

These flowcharts are a useful tool for the DME community to leverage while educating payers on the service-intensive component of the Industry, dispelling the commodification of DME while helping explain the elements beyond cost that need to be factored in setting reimbursement. The flowcharts are available on the Tools & Resources section of AAHomecare’s Website. We want to thank the Order Flowchart Work Group and the HME/RT Council for creating these resources.