Stakeholders look to Congress to pressure CMS on competitive bidding

WASHINGTON – Stakeholders urged members of the House Committee on Small Business during a recent Hill day to hold the Centers for Medicare & Medicaid Services (CMS) accountable for a new remote-item delivery (RID) framework for competitive bidding that they say will decimate small businesses.

Ahead of the fly-in, stakeholders have also been engaging the U.S. Small Business Administration (SBA) to raise similar concerns.

“We had a good meeting with committee members and they said, ‘We need a debriefing and hearings from CMS on this,’” said Tom Ryan, president and CEO of AAHomecare. “It would be a big deal to have a hearing to put CMS on record on how they’ve considered small businesses (in this program). We think it would be a difficult hearing for them.”

Stakeholders say the RID model – which would require national fulfillment capabilities – effectively excludes smaller providers, despite competitive bidding rules intended to accommodate their participation. They point to market data as evidence: CMS expects to award contracts to only 10 urological and ostomy providers, resulting in a 92% reduction in providers nationwide. For CGMs, it’s an 80% reduction.

One of the industry’s primary requests is for CMS to scale down the RID framework to regional markets instead of a national model.

“That’s a simple sub-regulatory fix,” Ryan said.

Simultaneous push to delay competitive bidding

Stakeholders also used the fly-in to make their case to potential sponsors for separate bills to delay competitive bidding for continuous glucose monitors (CGMs) and urological/ostomy supplies. There is a bill currently in the Senate to delay the program for CGMs for five years, but they’re working with both chambers on a more comprehensive bill for each product category.

With momentum from the fly-in, stakeholders expect these bills to be introduced soon – then the industry’s job is to be prepared to attach them to a broader health care package, possibly later this year.

“As the bidding process moves forward, it gets more difficult to change, but we do have time,” said Jay Witter, senior vice president of public policy for AAHomecare. “It’s an ongoing process, but the bills will be great tools to show support from committees of jurisdiction and congressional leadership.”

CMS is planning to announce specific dates for registration and bidding, as well as the lead items and number of contracts for each category, in late spring/early summer. It expects contracts to go into effect no later than Jan. 1, 2028.

With fly-in momentum, industry shifts to follow up

The fly-in generated 215 meetings with congressional offices, including:

• 62 meetings with committees of jurisdiction (up from 55 last year); and
• 28 meetings directly with members of Congress (up from 11 last year).

The work now is continuing to leverage the connections made and the conversations had during the fly-in. VGM & Associates is making a push for its members to follow up with stories from constituents about the importance of a robust and healthy HME industry.

“What we need to do is use the fly-in as a springboard,” said Ike Isaacson, senior vice president of government & regulatory relations for VGM. “We need to follow up and update elected officials and continue our story with them. The squeaky wheel gets the grease.”

Stakeholders are also following up on a recent meeting with CMS Administrator Dr. Mehmet Oz by sending a letter to him, as well as the agency’s staff, reiterating concerns and spelling out changes that can be made to the program through sub-regulation and formal rulemaking.

“The overall message from Dr. Oz and other CMS and HHS officials is that they are open to changes,” Witter said. “That’s not something that they’ve indicated in the past.”

Photo courtesy of AAHomecare.