Medicare legislation: HME at risk

Sunday, December 9, 2007

WASHINGTON - Sen. Max Baucus, D-Mont., chairman of the Finance Committee, was shopping around a Medicare package to the House of Representatives last week, and although the "details are still sketchy," it appears to include a severe cut to home oxygen therapy.

The package includes a provision to cut reimbursement for stationary concentrators by 40% to $120 a month and a provision to cut reimbursement for traditional portable oxygen tanks by a smaller amount, according to industry sources. It doesn't include a cut for new non-delivery technology: portable oxygen concentrators and transfilling concentrators.

"It's our understanding that, yes, there are provisions related to oxygen in the package," said Walt Gorski, vice president of government affairs for AAHomecare, on Thursday. "But we haven't seen anything in writing."

The oxygen cuts would help stave off a 10% reimbursement cut for doctors beginning Jan. 1. Baucus has struggled with Republican members of the Finance Committee, mainly Sen. Chuck Grassley, R-Iowa, over whether the Medicare package should include a one- (Grassley) or two-year doc fix (Baucus) and cuts to Medicare Advantage plans.

Last week, Baucus cancelled a mark-up of the package. Instead, he moved on to the House because he wants Medicare legislation passed this year.

"Baucus doesn't want a delay," said John Gallagher, vice president of government relations for The VGM Group. "He knows that next year, politics will take over, because it's an election year."

It's not clear whether the package includes a provision to eliminate the first-month purchase option for power wheelchairs. If it does, it will exempt complex rehab, industry sources said.

"There's nothing definitive (about rehab)," said Seth Johnson, vice president of government affairs for Pride Mobility Products.

It's unlikely Baucus will receive pushback from the House, at least on the HME provisions, say industry sources. The Ways and Means Committee has supported reducing the 36-month cap on home oxygen reimbursement to 18 months and eliminating the first month purchase option for power wheelchairs.

Industry sources worry Baucus could slip a Medicare package into an omnibus bill just before the holidays, blindsiding other legislators and the industry.

"That's usually when we get hammered," Gallagher said.

The industry's hopes may lay with the possibility that Congress will not have enough time to do all it has to do before the end of the year--defense bill, several appropriations bills, etc.--and decide to push Medicare legislation into next year.

Providers must continue educating Congress about the harm in cutting oxygen and power wheelchair reimbursement, industry sources said.

"The key is not to get bogged down by the (Nov. 30) New York Times article," Gallgher said. "That was meant to divert our attention. We need to stay focused on the Finance and Ways and Means committees."