A Legislative/Regulatory spotlight
Editor’s Note: Two short years ago, only two industry vendors - Invacare and Sunrise Medical - had apppointed people to work on legislative and regulatary issues as a titled, government relations expert. Today, six companies have created designated positions. Here’s what those folks have been up to, and what they’re planning to do.
Dave Williams, Director of gov’t affairs
I welcome this rare opportunity to comment on something other than competitive bidding. Until this issue is resolved one way or the other, there is little time for anything else. However, I continue to make time to devote to other endeavors on behalf of the HME Services industry.
First, over the past four months I have been responsible for organizing political fund-raisers for Senator Grassley (R-Iowa) and Congressmen Hobson (R-Ohio) and Brown (D-Ohio) that have netted a total of $200,000.00 between them. My current pro-ject in this area is a major event for the Bush/Cheney re-election effort later this fall.
Next, I have been passionately involved in the effort to get our industry to actively support accreditation. It will be part of any Medicare Drug/Reform legislation that may pass this year or next and the industry should be leading the charge, not dragging its feet. The industry should be demanding that accrediting bodies develop high standards that can be linked to positive patient outcomes and help suppress fraud and abuse. Our credibility, indeed our future depends upon how we respond to Congress on this single issue.
Finally, now and for the foreseeable future, I will be dedicating a major amount of time, money and energy trying to get my arms around the various attacks on the industry that are occur-ring at the state level. As money from Washing-ton gets diverted for tax cuts and to pay for the war in Iraq, 37 states find themselves unable to balance their budgets. Most of them are looking at the Medicaid program as the place to save money. In my mind, this is a bigger threat to our industry than NCB.
Martin Szmal, Director of gov’t affairs
Grassley. After throwing a fund-raiser for the senator at last year’s Med-trade, we convinced him to look at an alternate savings plan (CPI-freeze) to NCB. At follow-up meeting on Hill in May, we persuaded him a CPI freeze was far superior to competitive bid-ding. The senator decided to have CBO score the CPI freeze to support this idea, which he later introduced in the Senate bill.
Weekly Updates. In July, we began sending Pride customers weekly updates on leg/reg issues.
Grass Roots. Continue to mobilize the dealer base and mobilize members of the Owner’s Club, chiefly as letter writers in campaigns that are strengthened by the voice of the beneficiary.
Next 90 days. Working with local congressmen and senators to communicate with the Committee Conferees to express our position on NCB. We’re organizing another fund raising event for the most appropriate individual to further our cause.
Besides NCB. Lobbying to ensure that limits on use of extrapolation are part of the final Medicare reform. Also involved on state level, addressing cuts to Medicaid that are having an adverse impact on dealers and beneficiaries.
Darren Jernigan, Director of gov’t affairs
Medicaid. Crisscrossed country helping states understand Medicaid process from a manufacturer’s point of view. Discussing new power chair codes to why certain products are appropriate for different type diag-nosis a is priority.
Licensure. Tackled issue of certification. Tennessee was first state to pass legislation requiring certification to evaluate and supply a chair for long term use. Permobil is facilitating meetings to create similar legislation in six other states.
ATS/ATP Grant. If promoting licensure, companies should have suggestions not just questions or complaints. A $100,000 grant has been written to help individuals pay for RESNA sitting fee. Starting next year, pending approval, application process will be initiated.
NCB. Tremendous staying power here and a good chance of getting through com-mittee. A carve out for “assistive technology” is a focus to ensure rehab community is protected.
End Users. Taking message to non-profit organizations to encourage individuals with disabilities to be aware of options when purchasing wheelchair. Working with and educating more than 54 million Americans with disabilities to benefit both the industry and end-users.
Ron Billingsley, Director of gov’t affairs
NCB. Educated elected officials on this issue, including Rep Don Manzulla (R-Ill.), chairman of the Small Business Committee, who needed an explana-tion about compet-itive bidding pro-posal.
Respiratory Assist Device. Anticipating proposed rule to change payment category of non-invasive ventilation devices with backup rates from items requiring frequent and substantial servicing to capped rental. We did a great deal of research and alliance building on this issue when it surfaced a few years ago. We’ve re-engaged senators and members of Congress who supported the past challenge.
Recognition. Worked extensively to establish relationships and recognition within government since establishment of this position in Jan. 2003. Activties include efforts in Congress, state legislatures, professional associations, and regulatory agencies.
Next 90 days. HCPCS coding issues, both new codes and problems with HIPPA cross-over problems. NCB, or mandatory accred-itation issues if these provisions are included in legislation. Challenging wisdom and authority of CMS’ proposed rule change for respiratory assist devices.
The Future. Time is near when real reform must occur. I wonder why Congress would spent $400 billion to expand Medicare coverage when more than 40 million people have no healthcare coverage. We hope to participate in the debate.
Rita Hostak , V.P of gov’t relations
Coding. Countless hours on conference calls, meetings with suppliers and manufacturers to identify technology, develop definitions and clinical indicators for new code applications. Meetings at CMS, the SADMERC and communication with DMERCs.
Medicaid. With tremendous activity within the various MedicaidÂ pro-grams, we’ve spent a lot of time followingÂ the changes, commun-icating and part-nering with state associations to influence positive outcomes.
In-the-home. Working to have the interpretation of “in the home” under Part B Medicare changed. The cur-rent interpretation, which restricts access to products inside the patient’s home, has a significant impact on independence, quality of life and access to the community for millions of mobility impaired Medicare beneficiaries.
Next 90 days. Competitive Bidding and the Transaction and Code Set component of HIPAA and State Medicaid changes will be the three major areas of focus during the next 90 days.
Besides NCB? With so much focus on fraud and abuse and reimbursement restriction, we must work with regulatory agencies as well as legislators to find ways to ensure quality of products and services. Accreditation of suppliers, credentialing and certification of the individuals and state licensure are a few of the elements that may play a role in reaching quality outcomes. We will continue to work with the industry in each of these areas.
John Gallagher, V.P of gov’t relations
NCB. Grass-Roots Starter Kit. Presented thou-sands of HMEs with materials necessary to conduct grass-roots campaigns. Kit includes history of competitive bidding and focuses on negative effects to Medicare beneficiaries and families. (More than 10,000 beneficiaries have heard the presentation.)
States. At no cost, we attend most state and regional association annual meetings to provide legislative updates and lobbying advice. Attended 15 legislative town hall meetings in four states, to express importance of independent HME to Medicare benefi-ciary. Brought to-gether several key HMEs in Tennessee to schedule a meeting with the office of Majority Leader Bill Frist.
Washington. Deepened existing relationships with Sen. Grassley (Chairman, Senate Finance Comm.) and Rep. Nussle (Chairman, House Budget Comm.). Gained access to important D.C. corridors, including CBO, OMB, Senate Finance Committee meetings.
Next 90 days. Development of vgmMESA.net to offer state association leaders with a toolkit of services and resource library. Resources delivered via the Internet at no cost to state associations. Development of VGMPAC as conduit to active and effective participation in political process.
Besides NCB. Launching Medicaid Grass-Roots campaign to provide the necessary administrative support and resources to assist the associations in their efforts.