The American Association for Homecare is calling on the TRICARE military health insurance program and its contractors to reprocess HME claims from the second half of 2016 so that they are in line with the CURES Act.
One “ripple effect” of 2016’s national bidding expansion was that the TRICARE program, which bases its reimbursement for HME items on Medicare’s reimbursement rates, began cutting its reimbursement to HME providers when the full expansion cuts were implemented on July 1, 2016.
The CURES Act, which was signed into law in December 2016, provides retroactive relief to non-bid providers by extending the initial phase of partial reimbursement cuts to impacted items. That phase-in original ended on June 30, 2016, but the CURES Act pushed that a Dec. 31, 2016 end date.
Per section 16007 of the law, CMS must reimburse claims made after July 1, 2016 and before Jan. 1, 2017 with the difference between the full reimbursement cuts and the partial, phase-in rate.
AAHomecare contends that given that TRICARE sets its rates to Medicare reimbursement amounts by law and by current network agreements in place, TRICARE plans are obligated to adhere to CURES Act requirements.
The association noted that the organization has worked with healthcare attorneys to confirm that TRICARE should comply with the CURES Act and reprocess claims. The association laid out its arguments in a letter being sent to the three national TRICARE administrators and the Department of Defense.
“Congress recognized the need to provide relief for home medical equipment companies operating under drastic Medicare reimbursement cuts,” AAHomecare President and CEO Tom Ryan said. “It’s clear from current statutes and regulations that this relief is also applicable to the TRICARE program.”
“It is important that we fully examine how the CURES legislation will affect all payers for the HME industry,” noted Laura Williard, AAHomecare’s senior director of payer relations, who is tasked with improving relationships with non-Medicare payers served by HME providers. “Today’s letters are a first step in making TRICARE contractors aware of the changes in the fee schedules and starting the process of working with them to develop a plan that will ensure providers are paid accurately.
“AAHomecare is committed to serving as a strong advocate for HME to all payer segments,” she continued. “I look forward to both working directly with the TRICARE contractors and also developing the resources providers need to engage the contractors themselves.”
AAHomecare reported it will also provide guidance for its members on how to contact TRICARE contractors and encourage them to quickly address the issue.
“Home medical equipment providers take special pride in serving our nation’s military personnel and their families,” Ryan said. “We urge TRICARE to let our providers know how they plan to comply with the CURES legislation as quickly as possible so they can continue to support the military community’s healthcare needs.”