Will 'pay for' pass muster with CBO?

Friday, May 3, 2013

WASHINGTON – HME industry stakeholders expect to find out soon if the Congressional Budget Office (CBO) agrees that their bill to replace competitive bidding with a market-pricing program (MPP) is budget neutral.

“Now that the bill has dropped and now that the CBO has dealt with some of the other issues they’ve had to deal with, we expect a score to be coming,” said Cara Bachenheimer, senior vice president of government relations for Invacare.

Rep. Tom Price, R-Ga., introduced H.R. 1717 on April 24 with 25 co-sponsors.

Per the bill, in the time between competitive bidding ends and MPP starts, the industry would take a 25% cut in reimbursement, and Congress would cover the remaining 20% of the 45% cut planned for Round 2. The cuts, based on the fee schedule amounts not the bid rates, would be phased in over 18 months: 5% on July 1, 2013; 10% on Jan. 1, 2014; and 10% on July 1, 2014.

“With MPP, reimbursement starts fresh,” said Jay Witter, vice president of government affairs for AAHomecare.

For the national mail-order program for diabetes supplies, the industry would take a 10% cut on July 1, 15% on Jan. 1 and 15% on July 1, covering 45% of the 75% cut planned, and Congress would cover the remaining 30%.

Relying on Congress to pitch in on the “pay for” may seem like a big ask, but stakeholders say it’s not an uncommon legislative tactic.

“It’s only an issue when someone doesn’t support the idea, then they use it as an excuse,” Witter said.

If the industry and the CBO don’t see eye to eye on the “pay for” or the timeline for getting MPP up and running, stakeholders say they may have no choice but to negotiate.

“Can we offer something else?” said Wayne Stanfield, president and CEO of NAIMES, which will merge with AAHomecare on May 22. “Yes. We need to stop this.”

While the CBO score looms large, stakeholders are running with the bill.

“What we need to do as an industry is not wait for the CBO, but go back to legislators and get them to sign on to this bill,” said Seth Johnson, vice president of government affairs for Pride Mobility Products.