Four horsemen of HME

Friday, August 31, 2007

As 2007 progresses, the home medical equipment industry faces its own version of the Four Horsemen of the Apocalypse. The Biblical horsemen are pestilence, war, famine and death; our industry faces national competitive bidding, the oxygen cap, uncertainties surrounding complex rehab and, consequently, the likely elimination of many small to mid-sized independent providers.
Many in the industry denied that the apocalypse was real or that it would affect them. We now understand this thought process to be flawed. We have three major bills in the U.S. House of Representatives and two in the U.S. Senate that can be used to beat back the Medicare apocalypse. Let's look at each bill, and, importantly, see how they will benefit the provider and beneficiary.
H.R. 1845 - Medicare Durable Medical Equipment Access Act of 2007 (House's Tanner-hobson bill).
NCB doesn't stop with the first 10 metropolitan statistical areas. CMS has the authority to expand it nationwide in 2010. If passed, this bill would:
* Require quality standards (accreditation) to be implemented before NCB starts.
* Define significant savings as 10% or more from the Jan. 1, 2006, fee schedule. This means only products where a 10% savings can be expected would be bid; products that have already received reimbursement cuts/reductions should be exempt.
* Allow any qualified business--those that fail to win a bid--to continue to provide DME at the competitive bidding rate. (This is commonly known as the any-willing-provider provision).
* Restore the appeals process for DME providers in competitive bidding areas.
* Exempt from NCB rural areas, including MSAs, with less than 500,000 people, and urban areas with low population density.
* Require CMS to conduct a comparability study before an allowable rate from an MSA can be applied to other areas of the country.
* Require CMS to analyze the impact NCB has on beneficiary access and the DME provider community in the 10 initial MSAs.
* Require Congress to authorize the expansion of competitive bidding beyond the initial 10 MSAs.
H. R. 1845 has 105 co-sponsors as of July 30.
The effort to thwart the apocalypse that is national competitive bidding and the oxygen cap is very time-sensitive. Rep. John Tanner (D-Tenn.), lead sponsor of H.R. 1845, would like to attach this bill to the "must-pass" legislation known as the SCHIP (State Children's Health Insurance Program). If your congressional representatives and senators have not co-sponsored industry legislation, contact them and ask them to do so.
S. 1428 - Medicare Durable Medical Equipment Access Act of 2007 (Senate NCB bill).
Sens. Hatch, R-Utah, and Kent Conrad, D-N.D., introduced S. 1428. The differences between H.R. 1845 and S. 1428 are:
* The any willing provider provision only applies to companies with less than $6.5 million in sales--small businesses only.
* No analysis is required of the 10 initial MSAs.
* CMS can expand competitive bidding without specific authorization from Congress.
S. 1428 has 11 co-sponsors as of July 30. Differences in the House and Senate versions will have to be worked out in the conference committee.
H.R. 621 and S. 1484 - Home Oxygen Patient Protection Act of 2007
Rep.Tom Price, R-Ga., who is a physician, introduced H.R. 621; and Sen. Pat Roberts, R-Kan., introduced S. 1484. Both bills rescind the 36-month cap on home oxygen equipment and services.
President Bush's budget proposes capping oxygen equipment and services at 13 months--a potential savings of $6 billion.
H.R. 621 has 110 co-sponsors as of July 30, and S. 1484 has five co-sponsors as of July 30.
H.R. 2231 - Medicare Access to Complex Rehabilitation and Assistive Technology Act of 2007
Rep. Tom Allen, D-Maine, introduced H.R. 2231. The bill would exempt complex rehab equipment from competitive bidding. It had 12 co-sponsors as of July 30. There is no companion bill in the Senate.