It’s the 11th hour for bid bills

‘This is (the industry’s) Alamo,’ says VGM’s John Gallagher
Friday, December 11, 2015

WASHINGTON – Industry stakeholders hit the ground running last week with the introduction of a second bill that would lessen the impact of competitive bidding.

“We just have a few hours left to get this done,” said Jay Witter, senior vice president of public policy at AAHomecare. “We are doing everything politically, legislatively, and at the grassroots level.”

Introduced Dec. 8 by Reps. Tom Price, R-Ga., and Tammy Duckworth, D-Ill., H.R. 4185 is similar to its Senate companion bill, S. 2312, introduced Nov. 19 by Sens. John Thune, R-S.D., and Heidi Heitkamp, D-N.D.

The industry’s immediate plan is to get both bills attached to an omnibus bill that lawmakers must pass by Dec. 16 to avoid a government shut down. AAHomecare’s Tom Ryan says he’s as confident as he can be that industry efforts will pay off.

“(Lawmakers) are bargaining and negotiating,” said Ryan, president and CEO of the association. “All we can do is put ourselves in the best position and hope we’ve got a bipartisan, bicameral bill that’s paid for.” 

At press time on Friday, H.R. 4185 already had 36 co-sponsors.

If the bills don’t pass by the end of this year, stakeholders are committed to identifying another legislative vehicle in the first quarter of 2016. Once competitive bid pricing is implemented on Jan. 1, however, it will be harder to drum up support and providers will have tough decisions to make, say stakeholders.

“They are going to have to take a look at their business models and these rural areas they may no longer (be able to) cover,” said John Gallagher, vice president of government relations for The VGM Group. “This is their Alamo.”

Among the major provisions in the bills, the House bill has a 30% add-on to single payment amounts in all non-bid areas, while the Senate bill has a 30% add-on to rural SPAs, and a 20% add-on to regional SPAs.

“(It will) probably fall closer to the Senate provision,” said Ryan.

Other provisions include a two-year phase-in period; setting a ceiling for future rounds of competitive bidding at the unadjusted fee schedule rates in effect Jan. 1, 2015; and instructing CMS to revisit pricing adjustments for non-bid areas to take into account travel distance, clearing price and other associated costs for prices that will be in effect Jan. 1, 2019.

The House bill also contains a provision that would implement a demonstration project for a market-pricing program, something that Price has long been a proponent of. The 10-site demo would include the same DME items as the competitive bidding program, require binding bids, weigh historic capacity of the bidders, and determine the price based on the clearing price.