AAHomecare’s Ryan: Down But Not Out

Industry association leader explains next steps in reining in bid expansion.

Shaking off the frustration of not getting rural provider protection language incorporated into the recently passed omnibus spending bill, the industry is already pivoting into the next stage of the fight to reform bid expansion.

The American Association for Homecare has already been meeting with the industry’s key Congressional champions to determine the next steps in addressing the negative impact CMS’s plan to expand competitive bidding will have on patients and providers — particularly those in rural areas — when it begins Jan. 1, 2016.

“We’re still in the fight,” said AAHomecare President and CEO Tom Ryan in an interview with HME Business. “… There are two key bills, and we need to be active in getting co-sponsors.”

Ryan explained that the main reasons the industry’s language was passed over had mostly to do with the fact that there were too many “asks” competing for lawmakers’ attention as the bill was being hashed out, as well as that there was not much in the way of Medicare-related items in the $1.5 trillion spending bill.

“This [the industry’s language] just got off the high priority list,” he said. “No one objected to it. It was fair and they are committed to find a vehicle, and we’ve been told there will be a vehicle in early 2016.”

And the bills are making solid progress. H.R. 4185, the recently introduced Protecting Access through Competitive-pricing Transition (PACT) Act, already has 64 co-sponsors; and S. 2312, the DME Access and Stabilization Act, has 18 co-sponsors. Moreover, key Congressional decision-makers, such as Chairman of Appropriations Committee Rep. Hal Rogers (R-Ky.).

But, while that effort is under way, come Jan. 1, 2016, providers are going to have to make a business decision about what they want to do when bid expansion is implemented, Ryan noted. The program will be phased in, but it’s a relatively fast phase-in.

For pricing, CMS will use an un-weighted average of all of the single payment amounts (SPAs) for each of the categories from the CBAs to determine a regional single payment amount (RSPA) for each covered item. From Jan. 1 to June 30, 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, the rates will drop to fully implement the bidding-derived rates.

In the meantime, the industry will keep fighting to advance the two rural provider protection bills in order to halt the expansion as quickly as possible. Additionally, Ryan reiterated that there could Medicare legislation that could act as a vehicle in early 2016.

“There will be a bigger package,” he said. “I talked to our champions earlier today and it’s a ‘high, high priority.’ We need to keep it a high priority on the grassroots level so that leaders in the Senate and the House see it’s a high priority. There will be a vehicle in 2016, and we have to be a part of it.”

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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