Stay Vigilant in “Lame-Duck” Session of Congress

By the time you read this, the mid-term elections will have just ended. But does the result matter for the respiratory home medical industry?

Great strides were made in the last year. At the close of Congress’ 109th session, the Hobson-Tanner Bill had 149 co-sponsors and seven others had expressed a commitment to it. The Senate companion bill had also been introduced by Senators Orrin Hatch (R-Utah) and Kent Conrad (D-N.D.).

The next session of Congress will be a “lame-duck” session and, according to John Gallagher, VP government relations, VGM, “The chances of either bill moving forward are nil. The chances of getting the bills passed as separate appropriation bills are not good either especially in an election year and after a hard-fought partisan campaign. Members of Congress will return to work not wanting to do anything or compromise on anything.”

Instead, Congress will put forward an Omnibus Bill, “a hodge-podge” of appropriations bills, in which everything gets poured into a single bill. This is a real concern for the industry, says Gallagher: “We need to be vigilant and make sure that we keep talking to members of Congress so that there’s not something included in there that cuts off oxygen to beneficiaries at 13 months.”

So what can the industry hope for?
The ideal answer is to get language put into the Omnibus Bill that would “delay the competitive bid until everybody has the chance to meet the quality standards, and until they identify that the small business provider will be any willing qualified provider, as well as language to provide provisions within the bill so that there’s a legal and administrative recourse,” says Gallagher. Besides provisions for competitive bidding, the industry should lobby for language that removes the 36-month cap, and ensures that there’s no 13-month cap.

In addition to the Omnibus Bill, the industry still needs to work hard to get the message across about the value of the work home care providers do, for individuals, for the community and for the country. The report published in September by the Office of the Inspector General (OIG) on the cost and servicing of oxygen equipment indicates that there is still more to be done. The danger is that, even with all of its flaws, the report “may get some traction in congressional offices — but only if those offices don’t hear the full story from the home care and respiratory community,” says Michael Reinemer, VP, communications and policy, American Association for Homecare. “We circulated a detailed rebuttal of the OIG study. We have been reiterating that message in our ongoing Capitol Hill meetings and hope that providers will also express their concerns to their congressional members in the House and Senate.”

Lobbying is a long-term investment, but it may take some work to make it work. “It can’t be a one- time meeting with your member of Congress,” says Gallagher. “It’s got to be ongoing. Go sit down and talk about how the bill impacts beneficiaries, taxpayers and providers. We have to stop being reactive and be proactive.”

Medicare Durable Medical Equipment Access Act of 2005
Source: Last Chance for Patient Choice
On July 28, 2005, Congressmen David Hobson (R-Ohio) and John Tanner (D-Tenn.) introduced The Medicare Durable Medical Equipment Access Act of 2005. This bill would remedy many of the competitive acquisition provisions of the Medicare Modernization Act of 2003 (MMA).

The bill would:
• Require that competitive bidding not be implemented until quality standards are in place;
• Exempt smaller, rural (populations under 500,000) Metropolitan Statistical Areas (MSAs);
• Allow all qualified providers that are small businesses and that submitted a bid below the current allowable to participate at the selected award price;
• Restore the right of providers participating in the program to administrative and judicial review;
• Exempt items and services unless savings of at least 10% can be demonstrated, compared to the fee schedule in effect January 1, 2006;
• Protect beneficiary access to care by requiring CMS to conduct a comparability analysis for areas that are not competitively bid to ensure the rate is appropriate to costs and does not reduce access to care;
• Subject the CMS Program Advisory and Oversight Committee on competitive bidding (PAOC) to the Federal Advisory Committee Act (FACA), which requires public access to meetings and proceedings.

This article originally appeared in the Respiratory Management Nov/Dec 2006 issue of HME Business.

About the Author

Deborah Cooper is the former Respiratory Management editor.

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