WASHINGTON, DC – CMS is soliciting comments on adding ventilators and back/knee braces to the product categories included in the next round of the bidding program. MedPAC had identified ventilators among items with comparatively high Medicare reimbursement rates vs. private payer rates in their 2018 Report to Congress (see p. 150).
The prospect of adding ventilators to the bidding program should worry patients who depend on these highly specialized and service-intensive products, as well as clinicians and other caregivers who support this often-vulnerable patient population. The relatively small number of suppliers furnishing ventilators and the potential for severe harm to patients if access is further diminished makes ventilators a very bad fit for the bidding program.
AAHomecare will strongly encourage CMS not to add ventilators to the bidding program and will be working to ensure that other respiratory and relevant patient groups are also aware of this issue.
Find more information on the proposed HCPCS codes affected and how to comment here. Comments are due by 11:59 pm (ET) on Monday, Dec. 3.
“Final” Rule is a Starting Point for Securing Better Reimbursement Policies
WASHINGTON, DC – As the dust settles after the release of the long-awaited ESRD/DMEPOS Final Rule, the HME community can celebrate the most substantial infusion of Medicare dollars into our industry since the bidding program first took effect, as well as an important improvement to future bidding methodology. What’s more, the Final Rule is a tangible acknowledgement from CMS and HHS that the bidding program is in need of reform – a welcome change from their long-standing insistence that the program was not causing undue hardship for providers and patients alike.
So why does a $1 billion-plus win for HME nonetheless feel like a bit of a disappointment?
While the considerable relief for rural suppliers for the next two years is particularly welcome, the failure to address reimbursement rates for other suppliers in the gap before the next round of the bidding program takes place is unacceptable. Congress had made it clear that they believe that all non-bid areas should receive the 50/50 blended rate that rural areas are getting – a sentiment expressed in both the CURES bill and in report language in March 2018 Omnibus budget legislation, in addition to well-supported Congressional sign-on letters.
While the Agencies have paused the bidding program to allow time for reforms to be implemented, they are saddling suppliers in CBAs with rates based on this flawed program for at least two years. At the very least, all HME suppliers serving CBAs deserved retroactive CPI adjustment from the beginning of the last bidding rounds.
What’s Next for HME Suppliers?
While many suppliers in CBAs who did not win bids will take advantage of the chance to serve Medicare beneficiaries again during the gap period, they will be facing rates that provide razor-thin or even negative profit margins. Of course, every supplier, including current bid winners, will have to make their decisions based on their own economic reality and ability to effectively serve patients at these rates. It will be extremely interesting to see how the industry responds to this “opportunity.”
Beyond the gap period, suppliers will also have to educate themselves on how to approach the new Lead Item bidding methodology found in the next round of the bidding program. AAHomecare has joined other leading HME stakeholder organizations in developing an online educational resource on the next bidding round – dmecbpeducation.com – to help the HME community navigate changes in the program. We’ll keep you updated as significant new guidance and resources are added to the site before the next round, especially in terms of addressing the Lead Item bidding requirements.
The Rule is “Final” – But We’re Just Getting Started
Less than a week after the Final Rule was released, a sub-group of the Regulatory Council met in person to begin planning next steps to influence sub-regulatory guidance related to the Final Rule, as well as to address CMS’ plans to include ventilators in the bidding program (see more on that below). AAHomecare is also meeting with major oxygen and respiratory therapy groups on the ventilator issue and plans for addressing oxygen-related provisions in the Final Rule.
In the days following last week’s election, we were also on Capitol Hill to meet with key committee staff to discuss any opportunities for legislative action in the upcoming “lame duck” session, as well as laying the foundation to build on recent progress we’ve made in the House and Senate when the 116th Congress convenes in January.
The HME community has made significant progress in the past few years raising the visibility of our issues and establishing credibility on Capitol Hill. These positive developments in Congress, coupled with solid working relationships built with new leadership at HHS and CMS, have led to a string of positive developments for HME going back to legislation to ensure “binding” bids in the next round of competitive bidding, short term measures of relief for rural and non-bid suppliers in the CURES bill and the IFR, and finally securing longer-term rural relief and maximum winning bid methodology in the ESRD/DMEPOS Final Rule. All told, we’ve added more than $1.5 billion to the Medicare benefit, and we believe that we’ve been able to apply improvements to the bidding program that will result in more representative rates in future rounds.
Even with this string of successes, we’re frustrated that we haven’t been able to secure more sustainable reimbursement rates for all suppliers during the gap period. Like almost every supplier and HME stakeholder I’ve spoken with, I believe these wins are simply a starting point for the next phase of our advocacy work to establish a more sustainable Medicare reimbursement environment for HME – and I can assure you that AAHomecare is already at work to keep our industry moving towards that goal.
Tom Ryan is president and CEO of the American Association for Homecare.