AAHomecare Sets Aggressive Legislative Agenda

Efforts include pushing binding bids over the top, advancing MPP, audit reform, separate CRT benefit, prior authorization, state licensure effort.

LAS VEGAS, Nevada — The American Association for homecare outlined a broad legislative agenda for the 114th Congress during this morning’s Washington Update at Medtrade Spring 2015.

AAHomecare President and CEO Tom Ryan said, “We have more champions in Congress today than we’ve ever had."

Speaking before attendees at the Mandalay Bay Convention Center’s South Pacific ballroom, AAHomecare President and CEO Tom Ryan told attendees that the association has established solid legislative relationships with key committees such as the House Ways and Means and Senate Finance, and this has helped it begin to see success on which it can build.

“Our credibility and influence with the committees of jurisdiction is at an all-time high,” Ryan said. “We have more champions in Congress today than we’ve ever had.

“And that’s not magic,” he continued. “That’s because we’ve come the Hill every single day, because you’ve [providers] have come to the Hill every single day, and we’ve made a difference. We’re getting people to understand.”

AAHomecare has five key legislative initiatives for the current Congress, which Senior Vice President of Public Policy Jay Witter outlined for attendees:

  • Competitive bidding and the Market Pricing Program.
  • Audit reform legislation.
  • Prior Authorization.
  • Separate benefit legislation for complex rehab technology.
  • State legislative efforts, and state licensure in particular.

Competitive Bidding

Starting with competitive bidding, Witter noted that the association has seen a shift in strategy. While earlier efforts over the past several years have fixated on repealing the program, but after seeing binding bids legislation passed in the House, and companion legislation gaining momentum in the Senate, the association has outlined a multi-tiered plan for tackling CMS’s bid program.

The plan to expand competitive bidding nationally and fix bid amounts is "a ridiculous process. … So we’re working to address that," said Jay Witter, AAHomecare's senior vice president of public policy.

Witter noted that the recent success with H.R. 284’s passage under suspension of rules in the House hinged on convincing lawmakers that speculative bidding was actually happening. Now the association will focus on getting its Senate companion, S. 148, passed in the Senate by unanimous consent.

The industry will also work on the passage of legislation that would create a Market Pricing Program Demonstration Project, with Rep. Tom Price, who championed MPP legislation in the House during the 113th Congress, as a pivotal figure in that undertaking.

“[Price] is so passionate about that bill that he wants to see something happen,” Witter said. “He knows the MPP is a much better program than the current competitive bidding program.”

The association will also work with key Congress members on a legislative proposal that would address the expansion of competitive bidding to non-competitive bidding areas on January 1, 2016. While CMS has justified such a move by saying that without contracts, those non-bid providers will have greater access to market than provides in bid areas, AAHomecare’s Ryan noted such an expansion is a grave concern for rural providers.

“We can’t have expansion of competitive bidding overnight to the rural areas,” Ryan said. “You wake up the next morning and no expansion in market share and you decrease reimbursement by 50 percent? Outrageous. We can’t have that.”

Witter also noted that another key point of reform for CMS’s plan to expand bidding isn’t just the threat to rural providers, but that the rule fixes bid amounts. So if bid amounts can only go down with each re-compete, “eventually you’re going to have to pay CMS to serve patients,” he joked. “It’s a ridiculous process. … So we’re working to address that, as well.”

Other Agenda Items

For audits, the industry clearly needs reform, but Witter noted that the issues surrounding audits are neither exclusively legislative nor only regulatory; they are both. So, Witter and AAHomecare Vice President of Regulatory Affairs Kim Brummett have been coordinating their offices’ efforts to work in concert in order to change CMS’s audit program.

“This is a team effort, in which we hit the Hill and CMS in a coordinated effort,” he said. “… That is an approach that is building momentum.”

On the legislative side, the association will work with Reps. Renee Ellmers (N.C.) and Tammy Duckworth (D-Ill.) to reintroduce the AIR Act into the 114th congress. Ellmers had originally launched the legislation, which called for boosting transparency within the program; providing better education and outreach; and rewarding suppliers that have low error rates on audited claims. The bill lapsed with the end of that last Congress.

Duckworth, a war veteran and double amputee was an ideal champion to help back the new audit reform legislation.

“She knows this issue,” he said. “She knows clinical inference, which is in the legislation. She knows how important that is.”

Witter said the association would also work the Ways and Means Committee to include provisions of the new edition of the Air Act in committee bills, and added that the committee sees the legislation as even more viable than last Congressional term, when the bill had enjoyed good support. The association will also work to introduce a Senate companion to the pending legislation and work with the Senate Finance Committee to advance the legislation in the upper chamber.

Prior Authorization is a relatively new legislative item for the association, Witter said, but the association is now working on legislation now that the prior authorization project for power mobility devices is ending in August. He noted that the entities involved in that project would like to see the program be permanent.

The legislation would see providers being exempted from audits if they receive prior authorization notification. The exemption wouldn’t include fraud, obviously, but would cover technical errors. This would nationwide and for other DME items.

“That could save thousands,” he said.

When it comes to a separate benefit for CRT, Witter said that while the association has worked on such legislation in the past, “it is now a priority.” And perhaps the proof in that pudding would be recent news that a separate CRT benefit bill was recently launched in the House.

“The House bill has been introduced,” he said. “We’re now working on the Senate bill. This is something that is a non-controversial, smart policy idea that we can get passed into law.”

Lastly at the state level, Witter said the association is working to coordinate on state licensure laws. This includes efforts to work with state association to ensure that licensure is extended to “bricks and mortar” businesses to ensure out-of-area bidders with no presence in a competitive bidding area can place bids in that area.

“The states that are working for state licensure? We want to help them any way we can,” he said.

Call to Action

Witter said that the association will need providers’ advocacy support to advance such an aggressive agenda, and that providers shouldn’t feel nervous or reticent to pitch in.

“As you can see, we have a huge menu,” he said. “You should be able to find at least one of those issues that you are passionate about; that you can go to your members of Congress and say, ‘no matter what your politics are, no matter what your opinion is I have a menu of issues and you have to support one of those.”

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