AAHomecare: ‘This Bill Is Coming’

Association details efforts behind evolving legislation that would fix CMS’s competitive bidding expansion at Medtrade Washington Update.

Legislation to fix competitive bidding is coming and it’s coming soon, according to representatives of the American Association for Homecare, speaking at the organization’s Washington Update at Medtrade this week.

Speaking to attendees of the conference and expo on Tues., Oct. 27 at the Georgia World Convention Center, Tom Ryan, president and CEO of AAHomcare, and Jay Witter, vice president of Government Affairs for AAHomecare discussed the dangers of competitive bidding, as well as soon-to-be-released legislation coalescing behind the scenes.

As mandated by the Affordable Care Act, CMS is expanding competitive bidding prices nationally to claims for HME/DME covered Rounds One and Two of the program. This poses a significant challenge for HME providers in rural areas, who will not be able to make up for the serious reimbursements cuts they will face via increased volume or any other means.

CMS will phase in the rate cuts over course of 2016. An un-weighted average of all of the single payment amounts (SPAs) from the CBAs in each of the eight will be used to determine a regional single payment amount (RSPA) for each covered item, according to AAHomecare. From Jan. 1, 2016 to June 30, 2016, reimbursement for affected product categories will be based on 50 of the current, un-adjusted fee schedule, plus 50 percent of the RSPAs. Then, on July 1, 2016, the rates will drop to fully implement the bidding-derived rates.

As a result, Rep. Tom Price’s (R-Ga.) and Sen. John Thune (R-S.D.) are working to launch legislation for their respective chambers of the legislature that aim to mitigate the impact of the bid 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, rather than six months.
  • 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.

Ryan noted that despite the formative legislation’s many alterations to CMS’s expansion plan, it still gives CMS a $5.5 billion savings, which is close to its projected $7 billion saving. This is important because the industry has to strive to protect the value-added services it provides to patients.

“We’re saving the standard of care in this industry,” Ryan said, who explained the efforts to move the bill forward both behind the scenes and in terms of industry advocacy. “We’re gaining support, we’ve got a democratic co-sponsor.”

And that co-sponsor to Rep. Price is Rep. Tammy Duckworth (D-Ill.), who attached her name to the bill after much work between AAHomecare and the legislative staff of the VGM Group, led by John Gallagher, vice president of government relations for VGM, Ryan and Witter noted.

“This bill is coming ... We're not waiting.” Witter said, as he explained to the audience about the work being done on bid expansion legislation with Rep. Price in committee and to score the bill. “We’re working the committees; Dr. Price is working to get a CBO score, which is necessary; we’re doing it. We’re looking for any opportunity to pass this legislation this year.”

While the legislation is coming together, Ryan and Witter stressed the need for providers, their partners and their patients to impress upon lawmakers the dangers of expanding competitive bidding, and the need to support the legislation when it finally hits the House and Senate.

“You’re engagement is what’s going to make the difference,” Ryan told the audience. “I know we’re tired; I know we’re frustrated, but I’m telling you that you cannot give up. We have too much going forward.”

“When we ask for action, we don’t do it willy-nilly,” Witter added. “You can’t call a member of Congress every week; there has to be a reason for it. So we understand. But we’re at the point now where we need to step it up, now.”

Witter related a story that Rep. Price passed on to him that a member of the House Speaker’s personal staff came to him to learn more after Ohio constituents in particular had been calling his offices about the issue.

“That is what we need; that is gold,” Witter said. “If the Speaker’s office is getting those calls, everybody else should be getting those calls.”

About the Author

David Kopf is the Publisher and Executive Editor of HME Business and DME Pharmacy magazines. Follow him on LinkedIn at linkedin.com/in/dkopf/ and on Twitter at @postacutenews.

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