Bid Expansion Reform Not Part of Spending Bill

Rural provider protection was not put into year-end omnibus spending bill; effort to back bid reform and CRT protection bills continues.

• By David Kopf
• Dec 17, 2015

Legislative language that would have reformed CMS’s nationwide expansion of the competitive bidding program to lessen the burden on rural providers was not incorporated into the Omnibus spending legislation package that is slated for a Congressional vote on Friday, according to the American Association for Homecare. 

Provisions that were not included included language that would have lengthened the timetable for implementation of the expansion; decreased the reimbursement cut for rural providers; and protected funding for complex rehab accessories. The Medicaid “pay for” that industry advocates had targeted to help pay for the rural relief legislation has been included in the Omnibus legislation, with a 2019 effective date.

“This result is not a reflection of the amount of effort that our industry has extended at both grassroots and Capitol Hill lobbying levels, and we should all be proud of the way the AAHomecare membership, our state/regional association partners, and other leading stakeholder organizations and allies have come together to build support for these initiatives,” a statement from AAHomecare read.

The association reported that there might be other vehicles to which the legislative language could be attached, such as Medicare-related legislation in early 2016. Also, the association stressed that there is still opportunity to get its House and Senate rural protection bills passed during 2016, as well, and encourage providers to continue lobbying their lawmakers on their behalf.

Those two bills are H.R. 4185, titled The Protecting Access through Competitive-pricing Transition (PACT) Act, which was introduced into the House by Reps. Tom Price (R-Ga.) and Tammy Duckworth (D-Ill.); and S. 2312, the DME Access and Stabilization Act, which was introduced into the Senate by Sens. Senators John Thune (R-S.D.) and Heidi Heitkamp (D-N.D.).

Those bills would:

• Apply a 30 percent increase to single payment amounts (SPA), calculated on a regional basis, for suppliers in non-bid areas.
• Phase in the bidding-derived pricing over a two-year period in non-bid areas, rather than CMS’s six-month phase-in.
• Set the ceiling for future bidding rounds of the competitive bidding program at the unadjusted fee schedule rates that went into effect on Jan. 1, 2015, instead of CMS’ proposal to set a bid ceiling at the previous bid amount rates. The AAHomecare noted this is an important component of the legislation that will benefit all providers subject to competitive bidding rates in future bidding rounds.
• Instruct CMS to revisit pricing adjustments for non-bid areas that takes into account travel distance, clearing price and other associated costs for furnishing this equipment for prices that will be in effect on Jan. 1, 2019.

The House bill would also implement a Market Pricing Program (MPP) demonstration project in order to compare an alternative methodology for achieving sustainable savings while preserving access to medically necessary equipment, supplies, and services to beneficiaries.

 Also, providers were encouraged to continue advocating on behalf of legislation that would protect accessories for complex rehab wheelchairs. There are two bills the industry is trying to get passed: H.R. 3229, which was launched into the House by Rep. Lee Zeldin (R-N.Y.); and S.2196, launched into the Senate by Sen. Robert Casey (D-Pa.) with Sens. Rob Portman (R-Ohio), Chuck Schumer (D-N.Y.) and Thad Cochran (R-Miss.) as original co-sponsors for the legislation. The bills provide a technical correction that restricts CMS from applying Medicare competitive bidding program pricing to the accessories used with complex rehab wheelchairs.