Making headway on HME reimbursement issues

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Friday, October 20, 2017

There’s no getting around the fact that the HME sector remains under pressure thanks to significant cuts to Medicare reimbursement over the last few years. The effects of bidding program pricing, as well as the use of bidding-derived rates in rural and other non-bid areas, have hit almost every segment of this business hard. It’s a fact I know first-hand as the former head of a New York-based oxygen provider.

If you are an AAHomecare member, or you’ve been following our efforts in the trade press, you know that our top priority has been working to improve the reimbursement environment for HME suppliers. To this end, we continue to advocate for long-term improvements to the competitive bidding program, relief for non-bid area providers, and better audit policies, as well as working with state Medicaid agencies and other payers such as managed care groups, to secure sustainable rates.

Making headway in these areas can be a slow and often frustrating process. Fundamental reform of the bidding program, including increasing transparency of the program and implementing fairer methods of calculating bidding results, remains a high priority. We will continue to engage CMS and Capitol Hill with the aim of improving the program for the next bidding round, originally slated to go into effect in 2019.

CURES relief welcome news for many balance sheets

While we continue to work for these long-term fixes to the bidding program, last year’s CURES bill provided a measure of relief for many suppliers in non-bid areas. As the funds are finally making their way into HME suppliers’ accounts, I’ve heard from companies who have shared news of significant reimbursements: $2 million in one case, along with reports of $400,000, $500,000, and $1.7 million from others. In addition, related TRICARE retroactive reimbursements for the second half of 2016 are now being processed.

While we’re proud that our advocacy efforts have brought about tangible gains for HME suppliers, we won’t be satisfied until we can secure more long-lasting relief for non-bid area suppliers, as well as for other suppliers who service TRICARE beneficiaries or patients of other payers who are influenced by these rates. 

As of this writing, an Interim Final Rule (IFR) that would appear to address this issue is under review at the Office of Management and Budget (OMB). While we have had very strong engagements with CMS and HHS to move this effort forward, and have seen more than 200 members of the Senate and House asking for long-term relief, we are unsure whether the stunning departure of HHS Secretary Tom Price will impact the final release of the promising IFR.

CRT accessories relief and payer relations make a difference

AAHomecare and other stakeholders in the mobility arena also successfully lobbied to delay—and ultimately, permanently stop—the application of bidding-derived pricing for complex rehab technology accessories for Group 3 wheelchairs, and are working to build support for legislation that would also exempt manual CRT accessories from those cuts. Turning back those cuts for CRT will result in meaningful gains for mobility suppliers over the long term and allow them to keep serving individuals with profound disabilities who depend on these products.

AAHomecare’s increased investment in payer relations work has also paid dividends in several states. We’ve supported state and regional association leaders to stop or delay proposed Medicaid cuts in New York, Maine, and the District of Columbia, and we’re currently working on the issue in several other states. Our payer relations team also convinced TRICARE to retroactively reimburse suppliers based on the CURES-mandated relief I noted earlier. 

We can do more, with your help

I am excited by the fact that this year has seen HME advocates hold off proposed cuts at the state level and for CRT accessories, and that our efforts also led to additional payments to suppliers serving patients in non-bid areas and TRICARE beneficiaries. But it’s just a first step toward what we must achieve to give the HME community a fair and sustainable reimbursement environment.

The tremendous support we’ve had from suppliers, manufacturers, and other companies in the HME space who are a part of AAHomecare has fueled these accomplishments. These companies, through both their dues dollars and their engagement on advocacy issues, are why we have been able to considerably strengthen this industry’s influence and credibility on Capitol Hill and at CMS.

For the companies that aren’t yet part of our association, I hope you’ll look at what we’ve done and what we’re trying to achieve to help improve your balance sheet—and consider joining in our efforts as a member or by attending our next Washington Legislative Conference (May 23-24, 2018). I am confident that we are on a path to more significant and long-lasting public policy wins for the home medical equipment community and your support can help us get there more quickly.

Tom Ryan is president and CEO of the American Association for Homecare.

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