Stakeholders key up for small legislative window

Friday, September 18, 2015

WASHINGTON – It’s game time for the HME industry, with stakeholders expecting a bill to “fix” the nationwide expansion of bid pricing to drop in the next few weeks.

“We’ve got a very small window,” said Tom Ryan, president and CEO of AAHomecare. “Our providers across rural America have been very vocal this summer. (They don’t want to) wake up to see an overnight decrease of 45%.”

The bill, drafted by Rep. Tom Price, R-Ga., would provide a 30% increase in reimbursement over the bidding-derived prices and a four-year phase-in period, and reinstate the bid cap at the unadjusted fee schedule. It has been sitting in the Congressional Budget Office waiting for a score.

Stakeholders are counting on the momentum created during the August legislative recess—when providers across the country met with lawmakers in their home districts—to push the bill across the finish line.

“I’ve made a lot of Hill visits in the past two weeks and I was amazed at how many offices said they had been contacted by not just providers but also beneficiaries about the rollout,” said Cara Bachenheimer, senior vice president of government relations for Invacare.

Simultaneously, stakeholders are building support for a bill that would prevent CMS from applying bid pricing to accessories for complex power wheelchairs. Introduced July 27 by Rep. Lee Zeldin, R-N.Y., H.R. 3229 has eight cosponsors so far.

“Clearly we’ve got a long way to go,” said Seth Johnson, vice president of government relations for Pride Mobility. “It’s incumbent upon those who had meetings in August to follow up with members to let them know they really need to co-sponsor that legislation.”

One issue that remains a source of frustration: the reintroduction of an audit reform bill, something stakeholders had hoped to see last spring. Rep. Renee Ellmers, R-N.C., has been negotiating with the House Ways and Means Committee to include a provision to reinstate clinical inference.

“It’s getting to the point where we are putting some pressure on to get this thing dropped,” said Ryan. “We need this audit relief.”

AAHomecare in August released an analysis that found wait times for an appeal at the administrative law judge level has increased 25% during the first half of 2015 and projects a backlog of 3 million appeals by the end of 2016 if the trend continues.

“We believe if there was clinical inference, then you wouldn’t have that backlog,” said Ryan. “It should never have gotten to this level.”