Stakeholders eye upcoming payment rule

‘What will be the formula in non-bid areas?’
Friday, September 13, 2019

WASHINGTON – Industry stakeholders are stepping back to take a larger view of payment issues for HME, with the bid window for Round 2021 closing on Wednesday.

CMS is expected to release a rule next year that addresses the payment formula for HME, and the agency will have this most recent bid information at hand.

“What will be the formula in the non-bid areas, whether it’s the rural or the non-rural areas?” said Cara Bachenheimer, head of the Government Affairs Practice at Brown & Fortunato. “We want to make sure those rates are elevated to the 50-50 blend and the 75-25 blend.”

Getting H.R. 2771 passed would help. The bill, which would make permanent the 50-50 blended rates in rural areas and introduce 75-25 blended rates in non-rural, non-bid areas, picked up two new co-sponsors after lawmakers returned from the August recess, bringing the total to 36.

To add more pressure, stakeholders have been meeting with the office of Sen. John Thune, R-S.D., about introducing a companion bill, says Tom Ryan, president and CEO of AAHomecare.

“We’re making headway,” said Ryan. “We (hope to learn) in the next two weeks whether they will support it—I’m fairly confident they will.”

Efforts to get non-invasive vents removed from the bid program also continue, with patient groups like the ALS Association and the American Association for Respiratory Care taking the lead, says Ryan.

“Lawmakers know we are all aligned on this issue,” he said.

Even as the industry works to improve the existing bid program and carve out vents, a recent meeting of the Medicare Payment Advisory Committee (MedPAC) served as a reminder that not everyone sees the problems with the program. Staffers once again recommended expanding competitive bidding to include all DMEPOS, including supplies, orthotics and prosthetics.

“We’ll see what happens,” said Bachenheimer. “Any recommendations to Congress will be published in a report in the first half of 2020.”