WASHINGTON, DC – With the House currently on recess until after Labor Day (and the Senate set to join them later next week), the HME community can make a strong impression on their legislators via district-office meetings and at public events.  Our industry secured some important gains in the recently-released ESRD/DMEPOS proposed rule, and we have an opportunity to thank legislators who have been supportive on our issues for their efforts so far while also reinforcing that additional relief is needed.

Here are some key points you can make with your legislators in your recess-period contacts:

• Starting in January, all suppliers in competitive bid areas will be able to provide HME until CMS determines when the next bidding round takes place.  The current rates used in those bidding areas are unsustainable and need to be adjusted upwards in the interim period before the next bidding round in the Final Rule.
• The proposed ESRD/DMEPOS Rule provides a welcome measure of relief for rural suppliers, but does not address drastic reimbursement cuts for other suppliers in non-bid areas.  Maps are availableshowing the extensive non-bid areas not getting rural relief in many states (these are the green areas called “non-rural” in these maps).  Congress has repeatedly expressed their view that these non-bid areas also need the kind of relief afforded to rural areas; CMS needs to extend relief to all non-bid areas in the Final Rule.
• CMS has made it clear that they believe they do not have the authority to address the application of an outdated 2006 budget neutrality offset on oxygen equipment that is resulting in unsustainable rates for some oxygen products.  Congress needs to address oxygen reimbursement policy in the next healthcare related legislative vehicle.

This scorecard shows how your legislators have supported industry-backed initiatives such as the Congressional sign-on letter to OMB last September, the sign-on letter to Appropriations leaders this March, and co-sponsorship of HR 4229 and HR 3730.  Please don’t forget to note these actions of support in your meetings/contacts with your legislators.

GAO Calls for Stronger Oversight on Medicaid MCO Payments

WASHINGTON, DC – Last week, the Government Accountability Office (GAO), published a report titled, “MEDICAID MANAGED CARE Improvements Needed to Better Oversee Payment Risk.” Medicaid managed care accounted for almost half of the Medicaid federal spending in 2017; however, program integrity efforts have mostly been focused on Medicaid Fee-for-Service. Due to this, the GAO was requested to review potential payment and oversight issues with the Medicaid managed care program. While the report is not specific to DME, the GAO identified DME as one of the highest at-risk services for a payment error. This was reported based on the stakeholders interviewed for the report. Overall, GAO found that there needs to be more oversight by CMS with managed care organizations to prevent over-payments and compliance related issues.

You can read the full report here.