The president’s $4.1 trillion budget for 2017, which was submitted to Congress this week, contains multiple provisions that impact the HME industry, including a broadening competitive bidding’s categories and a removal of the rental cap on oxygen therapy equipment, according to analysis from AAHomecare.
The issue is whether or not Congress will ever hear those budget provisions. The budget committees of both the Republican-led House and Senate made the unprecedented move of refusing to give the budget a formal hearing. Since the 1970s, Congress has held hearings on formally submitted Presidential budget package. This week’s rejection, leaves those provisions in limbo.
That said, several provisions are pivotal for the industry.
To begin with, the budget would Expand Competitive Bidding to a broader range of Durable Medical Equipment product categories. The proposal would expand the competitive bidding program to additional categories, including inhalation drugs, all prosthetics and orthotics, and ostomy, tracheostomy, and urological supplies. The budget says it could save $3.8 billion over 10 years with such an expansion.
The budget would also repeal the 36-month rental cap on oxygen equipment while reducing the monthly payment amount for oxygen and oxygen equipment by the necessary percentage to be budget neutral. The goal is to improve beneficiary access to care, particularly when a patient relocates during the 36‐month period, but the question is by what percentage would funding be cut for the provision to achieve its state budget neutrality?
The President’s plan also includes $32 million for a state-level Assistive Technology Program that would provide financial assistance to increase the availability, access, provision, and training of assistive technology devices and services. Examples of such devices include computer or technology aids and modified driving controls, as well as DME such as wheelchairs and walkers.
Also included are several provisions aimed at strengthening CMS’s and states’ ability to fight fraud, waste, abuse, and improper Medicare payments. The proposal estimates $1.4 billion in PAYGO costs and $3.3 billion in non‐PAYGO savings over 10 years.
Additionally, AAHomecare isolated several key provisions concerning Medicare appeals:
- Allow the Office of Medicare Hearings and Appeals (OMHA_ and departmental appeals board authority to use a portion of Recovery Audit Contractor collections for the purpose of administering the Recovery Audit Program.
- Establish a refundable filing fee for Medicare Parts A and B appeals for providers, suppliers, and State Medicaid agencies, including those acting as a representative of a beneficiary, and requires these entities to pay a per‐claim filing fee at each level of appeal. HHS would invest the fee in the appeals system, and fees would be returned to appellants who receive a fully favorable appeal determination.
- Increase the minimum amount in controversy for Administrative Law Judge adjudication of claims to equal amount required for judicial review to the Federal Court amount in controversy requirement ($1,500 in calendar year 2016 and updated annually).
- Let OMHA establish a magistrate adjudication level for claims for amounts in controversy below new Administrative Law Judge controversy threshold amount.
- Establish expedite procedures for claims with no material fact in dispute to let OMHA issue decisions without holding a hearing if there is no material fact in dispute, such as appeals in which Medicare does not cover the cost of a particular drug or the Administrative Law Judge cannot find in favor of an appellant due to binding limits on authority.
- Remand appeals to the redetermination level with the introduction of new documentary evidence into the administrative record at the second level of appeal or above in order to incentivize appellants to include all evidence early in the appeals process.
- Allow the Secretary to use sampling and extrapolation techniques to consolidate similar claims into a single administrative appeal for administrative efficiency. Parties who are appealing claims included within an extrapolated overpayment or consolidated previously will be required to file one appeal request for any such claims in dispute.
While Congress might have initially given the President’s budget the cold shoulder, AAHomecare says it will further assess and monitor which if any of the HME-related proposals gain traction on Capitol Hill in other legislation, and provide additional analysis as needed.
Key links:
- The president’s budget: https://www.whitehouse.gov/sites/default/files/omb/budget/fy2017/assets/budget.pdf.
- Department of Health and Human Services budget brief: http://www.hhs.gov/sites/default/files/fy2017-budget-in-brief.pdf.