N.D. Lawmaker Helps Back Bid Expansion Reform

Sen. Heitkamp joins Sen. Thune as original co-sponsor of nascent legislative fix for national expansion of competitive bidding.

Legislation that would reform CMS’s nationwide expansion of competitive bidding rates is coming further into focus thanks to key support in the Senate.  Sen. Heidi Heitkamp (D-N.D.) has agreed to join Sen. John Thune (R-S.D.) as an original co-sponsors on emerging Senate bid reform legislation.

In the House Reps. Tom Price (R-Ga.) and Tammy Duckworth (D-Ill.) are developing legislation for that chamber. The exact details of the legislation are still being worked out for both the Senate and the House bills to ensure they have parity.

Starting Jan. 1, 2016, CMS will expand competitive bidding prices nationally to claims for HME/DME covered Rounds One and Two of the program.. 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. 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.

While still “under construction,” the formative House and Senate language will likely require the following reforms:

  • 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.

The effort to convince Sen. Heitkamp to help spearhead the legislation resulted from advocacy work done by North Dakota providers the Midwest Association of Medical Equipment Services, and the VGM Group, according to Barb Stockert, government relations for Sanford HealthCare Accessories. Stockert explained in an AAHomecare communication that  Heitkamp ‘s initial support to reform the expansion started with her singing a Senate letter to CMS asking for the agency to review the program before pushing it to implementation.

“We kept in contact with their offices about the issues we were seeing through the last year, including meeting with them at the AAHomecare Legislative Conference last May,” he recalled. “When the South Dakota providers met with Sen. Thune earlier this year and he agreed to work with Rep. Price, the industry needed a Democratic lead, and Sen. Heitkamp seemed like the logical fit. 

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.

HME Business Podcast