Senate bill revives fight against bid program

Friday, November 20, 2015

WASHINGTON – Stakeholders say the HME industry’s “work has just begun” now that a bill aimed at softening the blow of competitive bidding has finally been introduced in the Senate.

The provisions in S. 2312, introduced by Sens. John Thune, R-S.D., and Heidi Heitkamp, D-N.D., on Nov. 19, include a 30% increase to rural single payment amounts for providers in rural areas, and a 20% increase to regional SPAs for providers in all other non-bid areas.

“It’s time to start running,” said Tom Ryan, president and CEO of AAHomecare.

Other provisions in the bill include a two-year phase-in period starting Jan. 1, 2016 (a 50/50 blend of fee schedule and adjusted pricing in 2016 and 100% adjusted pricing in 2017); and a limit on the federal portion of Medicaid allowables to match the new SPAs in an area starting Jan. 1, 2020.

Stakeholders had to compromise on a number of provisions to get the bill introduced as budget neutral, the only way they say it will move by the end of this year. Originally, they had sought a 30% increase across the board in non-bid areas and a four-year phase-in period. The new provision adjusting Medicaid reimbursement to reflect the new pricing was also added as a “pay for.”

“The reality is there are two options,” said Cara Bachenheimer, senior vice president of government relations for Invacare. “Continuing with life as it is now, which is CMS’s plan, or embracing this package deal. In balance, is the package deal better or worse than today? I think most would say it’s better than today.”

Ryan agreed: “The numbers are much better than what we’re facing if this does not become law.”

Other provisions in the bill: a ceiling for future rounds of competitive bidding set at the unadjusted fee schedule rates as of Jan. 1, 2015; and a requirement that CMS revisit adjusting pricing for non-bid areas that takes into account travel distance, clearing price and other associated costs for furnishing equipment that will be in effect Jan. 1, 2019.

“The bid ceiling fix is significant,” Ryan said. “We negotiated hard for that and the other provisions in this bill.”

Following a congressional recess for Thanksgiving, stakeholders expect an identical bill, with the addition of a market-pricing demonstration project, to be introduced in the House of Representatives in early December. Then the plan is to attach both bills to an omnibus bill that must pass Congress by Dec. 10 to prevent a government shut down.

On the likelihood of all of these dominoes falling into place, Ryan said, “Absolutely, this has been part of the discussion all along. Everyone is aware of the timeline. Getting a bill out of the Senate is not easy and it’s finally been accomplished. But our work has just begun.”