Senate Finance Committee Pushes for Expansion Delay

Leadership of key committee in upper chamber urge HHS to delay the July 1 round of cuts that will impact rural patients, providers.

Leaders of the Senate Finance Committee have asked the U.S. Dept. of Health & Human Services to implement a 12-month delay the next round of reimbursement cuts associated with the national expansion of competitive bidding.

So far, providers impacted by the expansion have been affected by partial, phase-in rates, which began on Jan. 1. The July 1 cuts would see the full implementation of the bidding-derived rates.

In addition to the delay, the committee’s leadership called for HHS to disclose any specific indicators the agency is using to monitor any possible issues beneficiaries are having in accessing HME under the Medicare bidding program.

In a letter to HHS Secretary Sylvia Burwell, Finance Committee Chairman Sen. Orrin Hatch (R-Utah) and Sen. Ron Wyden (D-Ore.), the ranking Democrat on the Committee, stated the delay was necessary because CMS hasn’t adequately prepared for the possibility of reduced beneficiary access to HME/DME.

“Specifically, we are concerned that the current six-month period does not allow sufficient time to detect and correct problems and, as a result, puts beneficiaries at risk of experiencing a delay in the receipt of needed DMEPOS or being unable to obtain items altogether,” the letter reads. “It is unlikely that CMS will be able to monitor, analyze, and make any necessary changes prior to July 1, 2016.  The ability of the real-time claims monitoring that CMS uses for items provided in competitive bidding areas to assess the short-term impact of the DMEPOS fee schedule rate reduction in nonĀ­ competitive bidding areas is questionable.”  

The full text of the letter is available at http://bit.ly/1qG0HQm.

The Senators also suggest that HHS monitor changes in the percentage of suppliers accepting Medicare assignment following the Jan. 1 advent of bidding-derived rates, and also provide information on Medicare beneficiary complaints in the non-bid areas since that date.  

The association for American Homecare released a statement that it “applauds these Senators for their efforts to make sure the effects of significant initial reimbursement reductions for rural and non-bid area suppliers are well-understood and shared widely before additional cuts slated for July 1 take place.”

In light of the letter, the association pushed for providers to help advocate on the behalf of the Patient Access to Durable Medical Equipment Act of 2016 (S. 2736). That bill contains a variety of reforms for the national bid expansion, including these two key provisions:

  • Delay implementation of the second phases of reimbursement cuts for HME items in non-bid areas from July 1, 2016 until at least Oct. 1, 2017.
  • Replace the bid ceiling for future rounds of bidding with the unadjusted fee service rates from Jan. 1, 2015, rather than CMS’ current plans to cap future bid ceilings at the previous bid rates.

More on S.2736 available at http://bit.ly/1SzQGAX.

About the Author

David Kopf is the Publisher and Executive Editor of HME Business and DME Pharmacy magazines. Follow him on Twitter at @postacutenews.

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