Juggling act: Bidding, prior auths, accessories all in play

Friday, June 19, 2015

WASHINGTON – Industry stakeholders are pushing hard on multiple fronts with a nearly five-week summer recess looming in August.

The top priority: drafting language that would delay the Jan. 1 expansion of competitive bid pricing nationwide, something AAHomecare has been working on with Rep. Tom Price, R-Ga.

“The key is what it’s going to cost and how do we pay for that?” said Tom Ryan, president and CEO of the association. “From a grassroots standpoint, providers need to let (lawmakers) know, if they are in a rural area, what this means for their business.”

To that end, AAHomecare is partnering with The VGM Group on a study of the impact of competitive bidding so providers have hard data to back up their arguments.

The study focuses on access to oxygen in the original Round 1 bidding areas and will be conducted by an academic research group that recently did a similar study for diabetes supplies, says VGM’s John Gallagher.

“We already know the data shows, similar to diabetic supplies, that competitive bidding is causing problems and CMS is misleading Congress,” said Gallagher, vice president of government relations. “Because this is (an outside group) and peer-reviewed, CMS can’t say it’s just our industry numbers.”

Other priorities include attaching to the 21st Century Cures Act language to require prior authorizations for DME and to address payment reductions for accessories for complex rehab wheelchairs.

“There’s been positive reception to the PA language, and there’s sympathy on the accessories issue,” said Cara Bachenheimer, senior vice president of government relations for Invacare.

Rep. Marsha Blackburn, R-Tenn., introduced a bill in May that would require prior authorizations for high-dollar DME.

Even if the industry gets its language into the Cures Act, the bill, which was originally expected to move to the House floor last week, is unlikely to make it further than that, says Bachenheimer.

Still, “if you can get it into one package, it’s an easier lift down the line to attach it to another moving package,” she said.

Stakeholders have also gotten wind that CMS expects to publish a final rule before July 4.

“We don’t know if it has more meat on the bundling stuff, or a rethinking of how they want to calculate the pricing in the non-bid areas,” said Ryan. “We’re crossing our fingers that maybe this other rule is going to address the pricing.”