WASHINGTON, D.C. – Tom Ryan and Jay Witter were on Capitol Hill last week, joined by our lobbyists from the Nickles Group and Prime Policy, to advocate for S. 1294 and seek support for introducing CBA-relief legislation in the House.
One recurring message we heard in Senate meetings was that these offices are hearing from HME advocates on S. 1294, but that more outreach is needed to build co-sponsor support, especially among members of the influential Senate Finance Committee. Please continue to follow-up with offices you’ve made contact with and ask for their support and co-sponsorship on the legislation.
If you haven’t yet asked your Senators to support S. 1294, legislation to extend Medicare relief for suppliers in non-CBA/non-rural areas, please visit our Medicare Reimbursement Legislative Campaign Central to learn more and take action. Keep in mind that non-CBA/non-rural rates affect other rates, including Medicaid rates in 20 states, TRICARE, and rates from other payers who follow Medicare rates. Keep up the pressure.
Looking Ahead: Ensuring Sensible & Sustainable Rate-Setting Methodologies in Future CB Rounds
As we reported in late May, CMS has indicated that they are developing plans for a new competitive bidding round. Last week’s Hill visits also allowed us to begin discussing our priorities for future bidding rounds, including:
- Using maximum bid price for suppliers who are initially offered a contract for SPA, instead of median price results.
- Setting unadjusted fee schedule as bid ceiling instead of most-recent bid result pricing.
- Maintaining surety bond requirements.
- Ensuring CMS moves forward with CBP reimbursement rates, even if they are higher than 2016 rates, and set the SPA accordingly.
We plan to include CB program methodology among our issues for the September virtual legislative conference. See our new Issue Brief on CB program policy guidelines for more information.
CMS Publishes The Anticipated Coverage Pathway For Innovative Technologies
WASHINGTON, D.C. – On June 22, 2023, Centers for Medicare & Medicaid Services (CMS) published a notice with comment period titled, “Medicare Program; Transitional Coverage for Emerging Technologies” [CMS-3421-NC]. CMS proposed the Transitional Coverage for Emerging Technologies (TCET) pathway to allow faster access and coverage of new technologies for Medicare beneficiaries.
The TCET pathway is a voluntary process for manufacturers to submit to CMS for expedited coverage for certain FDA-designated Breakthrough Devices. This proposal comes after CMS repealed the Medicare Coverage of Innovative Technologies (MCIT) in 2021. The pathway utilizes the national coverage determination (NCD) and coverage with evidence development (CED) processes to accelerate Medicare coverage for new devices.
In addition to the procedural notice, CMS published three proposed guidance documents:
- Coverage with Evidence Development
- Evidence Review
- Clinical Endpoints Guidance for Knee Osteoarthritis
Stakeholders have until August 28, 2023, to submit comments to the Notice, and until August 21, 2023 for the proposed guidance documents.
Here are additional resources on the notice:
AAHomecare’s summary on the notice will be available soon on AAHomecare’s website.