In brief: Possible Medicare cut, Walmart MA initiative, BraunAbility testimony
By HME News Staff
Updated 8:41 AM CDT, Fri May 30, 2025
WASHINGTON – Legislation passed May 22 by the House of Representatives contains provisions that could impact home medical equipment, including a possible 4% cut in Medicare reimbursement, says AAHomecare.
The association’s analysis of the 1,116-page bill – H.R. 1, the “One Big Beautiful Bill Act” – includes:
Medicare
The cut to Medicare reimbursement rates across the full spectrum of health care providers is automatically triggered by legislation that causes significant debt increases –commonly known as PAYGO cuts. Congress could choose to block implementation of the PAYGO cuts, as it has done in the past, but that would include meeting a statutory requirement for a 60-vote threshold in the Senate. Congress could take that action any time before the end of 2025 to prevent those cuts from beginning in CY 2026.
Medicaid
Provisions including work or school requirements for Medicaid enrollees could result in 7.6 million individuals losing coverage and more than $600 billion in decreased spending in the program over the next 10 years, according to Congressional Budget Office scoring. The bill sets a deadline of Dec. 31, 2026, for all states to begin verifying work or exemption status at the time of both enrollment and eligibility renewal.
However, prospects for the Medicaid-related provisions in the legislation remain very fluid as some Republican senators have voiced concerns over the potential impacts on Medicare beneficiaries in their states, AAHomecare says.
Audits & AI
The legislation also mandates the use of artificial intelligence tools to identify and recoup improper payments in Medicare Parts A and B, setting a Jan. 1, 2027, implementation deadline. The bill directs HHS to produce an annual report on the success of the new AI tools, including detailing reasons for “failure” in the event their adoption does not achieve a 50% decrease in the improper payment rate. The bill allocates $25 million from hospital and supplementary insurance funds for FY 2025 to begin the AI effort.
Walmart launches Medicare Advantage initiative
BENTONVILLE, Ark. — Walmart is now allowing Medicare Advantage members to add their benefit cards to their online Walmart account to help them maximize their supplemental benefits.
Select customers can easily identify plan-specific, benefits-eligible products while shopping on Walmart.com and the Walmart app. They can track their benefits spending in real time and check out with a mixed basket of healthy food, over the counter (OTC) products and general merchandise for same-day pickup or delivery in as soon as an hour. Customers can also see a benefits tracker showing them how much they have left to spend.
“Customers expect more from their shopping experience, and we continuously adapt to offer the most convenient and intuitive capabilities,” said Ralph Clare, senior vice president, health & wellness merchandising, Walmart U.S. “We saw an opportunity to streamline the health benefits shopping journey, make it easier for customers to discover eligible items and offer convenient pickup and delivery options that fit their busy schedule.”
Walmart is also launching Everyday Health Signals for Medicare Advantage members with NationsBenefits to allow eligible members to receive free, personalized guidance that aligns with their wellness goals. The company is expanding the platform to more health plans and benefits managers.
“By allowing customers the opportunity to make more informed choices with Walmart Everyday Health Signals, we’re creating the opportunity for widespread health impact,” said Pravene Nath, MD, group director, consumer health and data solutions, Walmart U.S. “We’re innovating with tech-enabled health solutions that equip customers with a better understanding of how small decisions in the grocery aisle can help improve their overall health.”
BraunAbility president calls on VA to reduce 189-day payment drag
WASHINGTON – BraunAbility Americas President Craig Schrimsher testified before the House Veterans Affairs Subcommittee this week, advocating for long-overdue updates to policies impacting veterans in need of accessible transportation.
The testimony, shaped by input from BraunAbility’s dealer network and in partnership with the National Mobility Equipment Dealer Association (NMEDA), secured bipartisan commitments to address critical industry challenges, including:
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Improving fairness in the VA’s vehicle trade-in policy
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Reducing excessive payment delays to mobility dealers
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Updating the VA’s reimbursement schedule to reflect post-COVID inflation
One breakthrough in the conversation, according to BraunAbility: Securing commitments to tackle the VA’s 189-day average payment delay for mobility dealers.
"If we can cut a car in half and put it back together in three days, the VA can improve upon its 189-day payment cycle,” said Scrimsher.
State wins: Michigan, Arizona
Michigan’s Department of Health & Human Services (DHHS) recently updated annual quantity limits for CPAP and BiPAP supplies to allow for more frequent replacements on masks, tubing, filters and other related products across nine HCPCS codes, according to a bulletin from AAHomecare. “We’re thrilled that Michigan Medicaid has updated its coverage limits for CPAP and BiPAP supplies to better align with Medicare standards,” said Laura Haynes, president & CEO of the Michigan HomeCare & Hospice Association. “This is a major win for patients and providers and was a long time coming.” For most products, limits increased from one to two or three per year… Gov. Katie Hobbs has signed SB1132 into law, advancing diabetes care and patient choice in Arizona. Under the new law:
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Contractors are required to provide continuous glucose monitors (CGMs) through both the DME and pharmacy benefits.
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Prescribing clinicians will have the authority to choose the most appropriate channel for each patient.
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Coverage criteria for CGMs will be aligned with current standards of care, and consistent across both benefit types.
The law will help people living with diabetes and the DME community, reinforcing the role of providers in delivering critical technology and services to patients, says AAHomecare. The association's Payer Relations team worked with the Diabetes Council to advocate for this legislation.
Medline inks partnership with TenderHeart Health Outcomes
NORTHFIELD Ill. – Medline has entered into a distribution and supply agreement with TenderHeart Health Outcomes, a Texas-based provider, to use the Medline Home Direct Program to ship medical supplies directly to TenderHeart's patients' homes, including enteral feeding, urology, ostomy and wound care supplies; breast pumps; pediatric mobility aids; and a range of incontinence brands. The partnership will help facilitate TenderHeart's commitment to delivering innovative, clinically proven member-engagement and incontinence programs that improve patients' lives and broaden access to care, the companies say. "What stood out to me about Medline is the company's distribution capabilities and continuous investment in infrastructure and supply chain management," said Jason Wells, CFO, TenderHeart. "As we continue to expand our footprint to meet the needs of more patients, we remain focused on helping lower the cost of servicing the patient and driving innovation into the supply chain to ultimately deliver personalized care and improve health outcomes. I believe Medline has a high level of capabilities and resources to help us achieve our goals." Medline's ability to deliver next day to 95% of U.S. customers through its vast network of 45 distribution centers will help enhance consistent delivery of medical supplies to TenderHeart's patients, the companies say. Medline's two facilities in Katy, Texas, and Auburndale, Fla., are currently servicing TenderHeart's patients. As Medline continues to partner with home medical equipment providers, the company says it is investing in automation capabilities at its distribution facilities to help maintain the high level of service on patient-specific orders. "TenderHeart's collaboration with Medline brings several benefits, particularly in enhancing the patient experience," said Josh Bonnewell, corporate accounts director, Medline Post-Acute Care. "By leveraging Medline's high-quality products and solutions and supply chain network, we are focusing on helping TenderHeart optimize their business and enhance patient care."
Fraud watch: Braces, braces and more braces
Chula Vista, Calif., resident and business owner Fernando Valenzuela Ayub pleaded guilty in federal court May 27, admitting that he conspired with others to launder millions of dollars of health care fraud proceeds and paid unlawful kickbacks. According to his plea agreement, Valenzuela and co-conspirators owned and operated multiple DME companies, which sold orthotics – including back, wrist and knee braces – to Medicare beneficiaries. Valenzuela admitted that in operating the DME companies, he and co-conspirators paid unlawful kickback payments to sham marketing companies who provided bogus prescriptions for DME. In total, Valenzuela paid $3.7 million in kickbacks. Once Valenzuela’s DME companies were suspended from billing Medicare, Valenzuela conspired to put DME companies in the names of nominee owners while he maintained control of the companies and the monies received from Medicare. In total, Valenzuela billed Medicare approximately $51 million and was paid approximately $20 million and ultimately laundered at least $14 million of Medicare proceeds. As part of his guilty plea, Valenzuela agreed to forfeit $7,101,320. Valenzuela’s sentencing is scheduled for Aug. 15, 2025.
A former Kentucky resident was recently sentenced to two years and nine months in federal prison for engaging in a conspiracy to commit health care fraud in connection with durable medical equipment businesses. Reyes was also ordered to pay restitution in the amount of $6,004,916. U.S. Attorney Michael A. Bennett of the Western District of Kentucky and Special Agent in Charge Kelly J. Blackmon of the Department of Health and Human Services, Office of Inspector General (HHS-OIG), made the announcement. According to court documents, Pedro Reyes, 54, formerly of Elizabethtown, Ken., through multiple Kentucky companies, executed a scheme in which he fraudulently billed Medicare for DME like orthopedic equipment and back, knee and shoulder braces, that was medically unnecessary, unwanted by patients and not prescribed by their medical providers.
Smith+Nephew awarded military contract for NPWT
LONDON – Smith+Nephew has been selected by the U.S. Department of Defense through the Defense Logistics Agency to provide its Renasys Touch Negative Pressure Wound Therapy Systems under a single award, 10-year contract valued at up to $75 million. The systems will support military medical providers to administer therapy through prolonged casualty care, first surgical intervention, aeromedical transport and definitive care in military treatment facilities. “Future conflicts will be more difficult and complex,” said Dennis Lyons, MSG (ret), SO-ATP and Sr. director military & federal health for Smith+Nephew. “This implies medical devices and treatments will need to be simplified and more intuitive to be used farther forward by a wide range of providers. Renasys Touch NPWT will provide that simplified negative pressure wound therapy solution to the military care continuum for warfighters who need it most.” The Renasys Touch offers portability, an intuitive interface and the ability to provide a range of therapy modes, setpoints and cycle times that allow individualized patient care, the company says.
NikoHealth grows team
MIDDLETOWN, N.J. – NikoHealth has welcomed four new team members, including Ana-Rita da Silva as vice president of customer success to lead the company’s success and support organizations. She brings deep experience in building high-performing teams and delivering exceptional customer outcomes, with past leadership roles at Just Appraised, MindBridge AI and IBM. “As NikoHealth grows, maintaining the outstanding service our customers expect is more important than ever,” said the company. “We're excited to have Ana-Rita on board to help us elevate the customer experience and build a world-class success and support organization.” NikoHealth has also hired Adina Canada and Chris Dragatsis as sales development representatives and Nina Bleacher as an account executive. Canada has worked closely with clinicians and patients to drive adoption of innovative technologies. Dragatsis has a track record in sales and operations. Bleacher brings more than a decade of experience in healthcare technology, with previous roles at Phreesia and Brightree.
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Other recent news: NikoHealth integrates with AI platforms.
sovaSage hires Randolph to lead marketing
PITTSBURGH – sovaSage has named Robin Randolph as senior vice president of marketing. Randolph has more than 30 years of experience in sleep medicine, including a variety of positions in clinical settings, research, sleep lab operations and DME. Mos recently, she has focused on dental sleep medicine; previously, she held roles at Resmed and Fisher & Paykel. “We are thrilled to welcome Robin to the sovaSage leadership team,” said William Kaigler, CEO of sovaSage. “Her unparalleled expertise and passion for patient-centered solutions will be instrumental as we continue to scale and redefine what’s possible in sleep health.” In her new role, Randolph will lead all facets of marketing strategy, brand development and industry engagement as sovaSage continues its mission to deliver AI-driven solutions that empower providers, enhance adherence and improve patient outcomes.
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