Funding Focus

Politics Affects Payments

Many of us have little aspiration to gain political wherewithal. However, we continually seek knowledge that informs us of issues that affect the payment for our services. By the nature of the HME industry, the federal government is a key player in decisions regarding payment methodology. Payment dollars come from the collection of tax dollars, and as such, there are laws that govern how and under what conditions those dollars will be allocated.

Oftentimes, we complain about CMS and its implementation of payment policy, when in fact, CMS is implementing processes that have been put in place by the passage of new law. So as a favorite cartoon character of mine has said, a more correct adage would be, “I prefer to blame Congress.”

Leadership within our industry routinely ask the masses to speak to their elected representatives, schedule a site visit for an official to an HME location, or just get involved. Unfortunately when attending key events, it is often the same core group of people stepping up and carrying the message. Far too many of us don’t feel prepared to enter into discussions or know how to get started. It is imperative that all of us in the home respiratory supplier industry arm ourselves with a refresher course in government. The respiratory provider has never before been in such need of a collective voice.

Congress is made up of two bodies: The House of Representative (two-year term) and the Senate (six-year term). At times, there is thought to be more “responsiveness” from the House because they are generally driven to do what constituents from their districts want as memories of dissatisfaction are shorter.

“Oftentimes, we complain about CMS and its implementation of payment policy, when in fact, CMS is implementing processes that have been put in place by the passage of law.”

In order for a new law to be introduced, it is first brought forward as a bill. It can be introduced by either the House or the Senate. House bills start with HR and Senate bills start with SB. A bill must be reconciled between the House and the Senate before being signed into law.

Each arm of Congress has various committees and subcommittees that work within certain projects or issues. Success within our industry is influenced by the House of Ways and Means Committee, and the Energy and Commerce Committee. Within the Senate, there is great influence by the Senate Finance Committee. One should note that statistically only two percent of bills that come out of the sub-committee actually get through for signage. For success, it requires a champion who is often named as sponsor of the bill or works behind the scenes to push the legislation through.

Once a bill is introduced it has to go through mark-up which is a process of better defining the details and determining issues. It is the responsibility of the Congressional Budget Office (CBO), which is staffed by primarily economists and public policy analysts to score bills. Congress mandates that the CBO provide them with objective nonpartisan and timely analyses to aid in economic and budgetary decisions related to programs that are covered by the federal budget.

The scoring process is critical, especially now with a mandate for a “Pay-Go Congress.” This simply means that more spending on things such as entitlement programs or tax cuts will have to be offset by either tax increases or spending cuts elsewhere.We often hear this referred to as budget neutral.

Members of Congress try to gain support for their bills by getting signatures from more influential members and taking on such tasks as generating “Dear Colleague” letters where they explain the position and value of the proposed bill. Once a bill has been introduced, it opens the door for discussion with your representative. It is often not the representative themselves you will be speaking to, but rather a health legislative aide who is often young and has very little experience with the issue you want to discuss, and has no less than a dozen people after you lined up to discuss their very important issue. The sheer number of contacts is key to gaining their support.

Recently, our industry has had different bills introduced into Congress. The Home Oxygen Patient Protection Act (HR 2373), the Medicare Home Oxygen Therapy Act of 2009 (HR 3220), and there is yet another one. When you see various analyses completed, it’s important to look for data that comes from a source with as little bias as possible and a proven track record of supporting the industry and its views.

It is important that we get one collective voice on the hill. Learn how to contact your Representatives and Senators by going to and Be sure to note what committees they serve on.

This article originally appeared in the Respiratory Management September 2009 issue of HME Business.

About the Author

Kelly Riley, CRT, is director of The MED Group's National Respiratory Network and has more than 25 years of experience in the respiratory arena.


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