2008 Funding Forecast

Competitive Bidding, First-Month Purchase Options for PWC & a New Medicare Program are Issues to Watch

It’s a presidential election year; what does that mean for HME funding and policy issues? We asked Seth Johnson, VP of government affairs for Pride Mobility Products, how he expects politics to influence HME policy in 2008, and what other funding hot spots he’s keeping an eye on. — Ed.

HME Business: What legislative policy and funding “hot spots” will you be watching during 2008? What topics are cause for concern or optimism?

Seth Johnson: The main issues that we plan to follow closely and be actively involved in are many of the same issues that we battled in 2007. By the time of this publication, the outcome on the Medicare bill and the proposed elimination of the first-month purchase option for power wheelchairs should be decided. However, this is an issue that regardless of the outcome, the industry will need to continue to monitor at a minimum and may need to work more closely with policymakers on.

In addition, the competitive bidding program, both implementation of the initial 10 competitive bid areas (CBAs) and the expansion of the program to the next 70 areas, will be a big focus. Also, efforts will continue to gain further clarification, guidance and education from CMS/DME MAC Medical Directors on the Medicare documentation requirements for power mobility devices (PMDs); the development of new manual wheelchair coding, coverage and pricing; and state Medicaids will be a focus in 2008.

HMEB: What HME-related issues are you personally working on right now, and how are you working to advance your positions/opinions?

Johnson: We are very engaged in efforts to preserve the power wheelchair first-month purchase option, and in addition to our efforts as a manufacturer, we are working directly with providers, clinicians and consumers in the states of key decision makers. We are also engaged in efforts to obtain additional clarity, guidance and education on the PMD documentation requirements and are closely monitoring the competitive bidding program and taking action as necessary.

HMEB: What is the general mood in Washington regarding HME right now? Is the value of home care spreading, i.e., is the word getting out?

Johnson: It really depends on who you talk to on the Hill. With the recent reports highlighting the fraud that was perpetrated by unscrupulous providers years ago (see this issue’s News, starting on page 8), that issue continues to be a concern for many legislators. However, the advocacy efforts and relationships that have been built on the Hill have helped provide new avenues to get the industry’s message out on the Hill in support of higher standards and mandatory accreditation. The value of home care message is spreading and is one that I do not find being questioned in my meetings on Capitol Hill.

Clearly, we need to do more to articulate this message with legislators and position home care as part of the solution to the health-care crisis and one that will help extend the solvency of the Medicare program.  

HMEB: How do you expect Congress’ activities in 2008 to be affected by the elections? What can we do to make sure our voices are heard?

Johnson: Presidential election years are very difficult years for Congress to do much of anything significant, which is not necessarily bad. However, election years also provide great opportunities to get legislators to help, since they are up for reelection and want to be able to show how they have helped constituents (voters) with their concerns in order to secure your support for reelection.

HMEB: Overall, what do you think the funding climate is like right now? Do you expect HME to have another challenging year? Are there any “bright spots” on the horizon?

Johnson: I think it will continue to be challenging, although the extent to how challenging it will be will largely be contingent upon what happens in a final Medicare package. I think there may be some opportunities to make positive changes this year, but until we know the outcome of the Medicare package, it is difficult to point to specifics, as that outcome will determine a lot as to our 2008 strategy and the next steps that need to be taken. n

This article originally appeared in the January 2008 issue of HME Business.

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