CMS does ‘whatever it wants,’ say frustrated stakeholders

Adjusted fee schedule not what Congress intended, they say
Friday, May 5, 2017

WASHINGTON – While there is “no question” that Congress intended for CMS to reset rural and non-bid area rates for the second half of 2016 to match those of the first half of the year, the agency’s decision not to was, technically, legal, say industry stakeholders.

“From a strictly legal perspective, CMS is acting within the bounds of the law,” said Cara Bachenhiemer, senior vice president of government relations for Invacare. “So it’s a very difficult legal argument to make, saying that congressional intent trumps the actual black and white letter of the law.”

The agency released the updated fee schedule to meet a provision in the Cures Act that requires the agency to retroactively delay a second round of reimbursement cuts that went into affect in those areas on July 1, 2016, until Jan. 1, 2017, allowing HME providers to recoup six months worth of payments.

Unfortunately, CMS recalculated the rates based on the July 1, 2016, fee schedule instead of the Jan. 1, 2016, fee schedule, resulting in rates that are lower than they should be.

“We argued our point with the agency and they stuck with their interpretation,” said Tom Ryan, president and CEO of AAHomecare. “Many people on the Hill are disappointed.”

Many providers, meanwhile, took to Twitter to vent their frustration.

“Medicare does whatever they want, without any fear of industry efforts or congressional intent,” read one tweet.

“@SenPriceMD this has to stop. They are openly defying a congressional order. No one has the guts to stand up to them,” read another.

With the fee schedule coming on the heels of recently released CMS data that shows a 41% decline in the number of HME providers since July 2013, provider frustration is understandable, says Ryan, who received some “unpleasant calls” from AAHomecare members last week.

“They are outraged and they should be outraged,” he said. “They need to come out and show that sense of outrage to members of Congress—that this is a small industry being attacked by CMS.”


So.... Congress says - "Give these people (Us) back X amount of money" (seems pretty clear to me) - Then CMS says - "No - We don't think that is what Congress meant"

That is about like the cop stops you and looks in your car and says - "Oh, I see you have an Open Container of Beer - I am going to have to give you a Ticket."  You reply - "I don't interpret it that way Officer.  You see, I have my hand over the Beer so it is not Open."  See how far you get with that.  -- "What you in Jail for???"  - Answer -"Being a Smart-Aleck."

This is CRAZY - And we have little or no recourse?  If Congress passes laws and the agencies don't want to enforce them - This country is in Real Trouble.  So...... See Previous Note.