Stakeholders prepare for ‘complicated’ post-election activity

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Friday, October 21, 2016

WASHINGTON – The chairman of the House Energy and Commerce Committee could be one thing standing between the HME industry and competitive bidding relief after the elections.

While Rep. Fred Upton, R-Mich., doesn’t have substantial objections to the industry’s efforts to retroactively delay a July 1 cut in Medicare reimbursement in non-bid areas, he’s laser focused on getting the 21st Century Cures Act passed before the end of the year, stakeholders say.

“It’s complicated,” said Cara Bachenheimer, senior vice president of government relations for Invacare. “He wants the DME pay-for for his legislation, which has a shot at going forward after the election.”

Stakeholders and their champions in Congress have been struggling to get agreement on a pay-for for their delay. One of the pay-fors in the Cures Act would reduce Medicaid rates to Medicare rates for certain HME included in the competitive bidding program starting in 2020.

The only pieces of legislation likely to move forward when lawmakers return to Capitol Hill in November are those, like the Cures Act, that have been prioritized by leadership. That’s why stakeholders take comfort in assurances from House Speaker Paul Ryan that he will take up legislation addressing bid relief before the end of the year.

“Leadership is going to drive this,” said Bachenheimer. “All the outstanding issues will get tossed to the wayside unless they are a priority and that’s why the signal from Ryan is important.”

Best-case scenario: The delay gets folded into a spending bill that lawmakers must pass to continue funding the government beyond Dec. 9, stakeholders say.

“It’s difficult to predict what’s going to happen,” Bachenheimer said.

Meanwhile, evidence continues to pile up that the bidding program is creating access issues for Medicare beneficiaries and needs to be addressed. The number of beneficiaries receiving DMEPOS in Round 2 areas decreased 17% from 2012, the year before bid pricing went into effect, to 2014, the year after, according to report published by the Government Accountability Office on Oct. 17.

“That raises a lot of questions,” said Bachenheimer. “You can’t just sweep it under the rug which is what CMS keeps doing.”