Lawmakers Prep Bid Expansion Legislation

Rep. Price, Sen. Thune are working on legislation that would rein in CMS’s plans to expand competitive bidding to non-bid areas on Jan. 1, 2016.

As CMS’s Jan. 1, 2016 date for implementing a nationwide expansion of competitive bidding pricing to non-bid areas quickly approaches, lawmakers are crafting a legislative response to keep that enlargement in check.

Already, Rep. Lee Zeldin (R-N.Y.) introduced H.R.3229, a new bill that will prevent CMS from applying competitive bidding-derive pricing to complex rehab wheelchair accessories.

And now, to address the expansion as a whole, the American Association for Homecare is reporting that Rep. Tom Price’s (R-Ga.) is working to launch legislation that would take the sting out of the expansion. Specifically, the legislation calls for:

  • Establishing a single-payment-amount-plus- 30 percent adjustment to help rural providers survive cuts that they could not replace with additional volume, due to the geographic limitations of their markets.
  • Providing a four-year phase-in for the national price adjustments.
  • Reinstating an unadjusted fee schedule as bid cap, instead of CMS proposal for cap at previous bid rates.
  • Providing for a demonstration project for a market pricing program (MPP) approach, similar to the approach Rep. Price outlined in H.R. 1717 in the 113th Congress.

In the upper chamber, Dr. Price is reportedly working with Sen. John Thune (R-S.D.) to create companion legislation.

It will be critical for all providers, large and small, urban and rural to get out and support the legislation, because an expansion will impact all providers, not just some, noted Tom Ryan, president and CEO of AAHomecare.

“… If we don’t get this legislation moved along and passed I think we’re going to have some serious access issues in the rural areas, because I’m not sure how the people in those areas can stand any adjustments of that magnitude without any increases in market share,” he explained. “Everybody wants to be involved in advocating for this phase-in legislation, and SPA-plus-30, because if we see an overnight expansion of competitive bidding rates in the majority of the non-bid areas, the third-party payors are going to be looking at those rates, and we are going to be seeing a tremendous cut in our other third-party payors.”

Bearing that in mind, Ryan advised providers to contact their Representatives and Senators and alert them to the dangers posed by the bid expansion, and how their businesses and patients will be negatively impacted.

“You can also ask that they be on the lookout for legislation to address the issue soon,” Ryan added.

About the Author

David Kopf is the Publisher and Executive Editor of HME Business and DME Pharmacy magazines. Follow him on Twitter at @postacutenews.

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