Senate Passes CURES Act

Pres. Obama is expected to approve legislation, which provides rural bid relief; AAHomecare head Ryan addresses debate over a key pay-for provision.

• By David Kopf
• Dec 08, 2016

In a 94-5 vote, the Senate has passed the 21st Century CURES Act, which includes provisions that offer relief to providers and patients affected by the national expansion of competitive bidding to non-bid areas.

Passed by the House last week, the CURES Act provides retroactive relief to non-bid providers by extending the initial phase of partial reimbursement cuts to impacted items from ending on June 30 to ending on Dec. 31, and pushing implementation of the full reimbursement cuts, which had started on July 1, cut to Jan. 1, 2017. CMS will reimburse post-July 1 claims for the difference between the partial reimbursement cut and the full reimbursement cut.

President Obama has expressed support for the CURES Act, which incorporates a far-reaching range of healthcare provisions, and is expected to sign it into law.

“The bipartisan passage of the 21st Century Cures Act is an example of the progress we can make when people from both parties work together to improve the health of our families, friends and neighbors,” Pres. Obama noted in a public statement, released after the Senate’s passage of the Act.

“The Cures Act makes important investments that will save lives,” he added. “… This bill will make a big difference, and I look forward to signing it as soon as it reaches my desk.”

Other key, bidding-related provisions in the CURES Act:

• The legislation delays the application of competitive bidding-derived reimbursement cuts to accessories for Group 3 complex rehab mobility devices another 12 months until July 1, 2017. A previous 12-month extension had been secured in December 2015.
• The bill instructs the Department of Health & Human Services to study on the impact of the bidding program on the total population of HME providers and patient access to HME over the course of 2016.
• In order to provide more permanently relief to rural HME providers and patients, the legislation requires HHS to reissue payment regulations for items and services furnished on or after Jan. 1, 2019, with adjustments to the non-bid fee schedule in some areas based on stakeholder input, costs, volumes and the population of suppliers serving those areas.

“This is an important win for HME providers and patients in rural communities and other areas not covered by the bidding program,” said Tom Ryan, president and CEO of the American Association for Homecare. “We look forward to building on today’s action to get longer-term relief for our industry in the 115th Congress and by working with the incoming Administration on a more sustainable reimbursement environment for HME.

“I want to especially thank our most steadfast champions on Capitol Hill, Congressmen Tom Price R-Ga.), Dave Loebsack (D-Iowa) and Peter Welch (D-Vt.), as well as and Senators John Thune (R-S.D.) and Heidi Heitkamp (D-N.D.), for their leadership in making sure the HME infrastructure can continue to serve the needs of the millions of Americans who rely on our products and services,” he added.

Pay-For Controversy

Given the congressional desire for budget-neutral legislation, one of the CURES Act’s pay-fors comes in the form of an acceleration of the plan to limit state Medicaid reimbursement rates for HME to the Medicare fee-for-service payment rates, including items those will competitive bidding-derived rates. Rather than apply those rates in January 2019, the application would be ramped up by one year to Jan. 1, 2018.

This has caused some controversy, in that many believe the accelerated schedule was the mechanism for obtaining the rural relief provisions. AAHomecare’s Ryan said the two provisions are not connected.

“There was no ‘trade’ of accelerated Medicaid cuts for rural relief — this pay-for was always going to be one of many others used to help fund CURES legislation, and that’s been the intention of powerful House members pushing the entire package for quite some time,” he explained. “This wasn’t an idea that we offered up or had any choice in. The unfortunate reality is that some parties in Congress recognized the disconnect between Medicaid rates and the rates generated by the bidding program and saw that as potential ‘savings’ they could apply to their own interests.

“It’s a similar situation to where the original move to cap the Federal contribution for Medicaid at bidding-derived rates starting in 2019 originated — that provision was used as a ‘pay for’ to extend funding for 9/11 first-responders’ healthcare and victim compensation in December 2015 omnibus spending legislation,” Ryan continued. “To put it simply: the Medicaid pay-for was going to be in CURES whether we managed to get our provisions included or not.”

The full legislative language of the CURES Act can be found at http://bit.ly/2fRK7Yf, with the provisions related to CRT accessories found on page 794, and the rural relief provisions found on pages 795 to 799, according to AAHomecare.