Cures Act has wins, losses for HME industry

By Theresa Flaherty, Managing Editor
Friday, July 10, 2015

WASHINGTON – A bright spot in the high-profile 21st Century Cures Act that the House of Representatives passed on Friday: a provision that would extend CMS’s PMD demo.

The provision would extend the demo, which requires prior authorizations for certain PMDs, through at least Aug. 31, 2018.

“It’s a really big step forward in terms of expanding the demo nationwide,” said Cara Bachenheimer, senior vice president of government relations for Invacare. “This was language that the industry strongly supported.”

The demo, which kicked off in seven states in September 2012 and was expanded to an additional 12 states in 2014, is set to expire this Aug. 31.

The provision also gives CMS the authority to expand the demo beyond the current 19 states and expand it to include all PMDs, options and accessories. 

“We’re hopeful CMS will move forward on its own,” said Bachenheimer.

Although the PMD demo has proven popular with providers and has the support of CMS, until now, there were no plans to extend it.

“Stopping the demo is in no one’s best interest,” said Seth Johnson, vice president of government affairs for Pride Mobility.

Another bright spot in the bill: a provision that would limit audits of claims that have already had an advance determination of medical necessity.

Other HME-related provisions in the bill aren’t as popular, including a pay-for that seeks to reduce Medicaid rates to Medicare rates for certain HME included in the competitive bidding program starting in 2020, and a proposal to pay for Part B infusion drugs using an average sales price model.