Whitehouse Budget Includes HME Proposals

Budget package proposes policy changes such as competitive bidding revisions and eliminating face-to-face requirements.

This White House’s budget proposal for the fiscal year 2019 contains a number of far reaching HME-related provisions that elicited some concern from the American Association for Homecare.

“AAHomecare has especially strong concerns about the first item noted below and plans to talk to the Administration for clarification,” the associated noted in a public statement regarding the budget.

The HME-related provisions of the bill:

  • Reform the competitive bidding program to pay winning supplies at their bid amounts, rather than on a median the bid amounts.
  • Reform the competitive bidding program to expand bidding across the entire nation, including rural areas, with rural providers bidding against other rural providers. In instances where only one rural provider serves a bid area, CMS will use reimbursement rates from a similar rural area.
  • Eliminate Medicare’s requirement that a beneficiary have a documented face-to-face encounter with a physician or non-physician practitioner in order to approve DME claims
  • Use Medicare’s demonstration authority to test whether using a benefits manager for DME claims that requires refills or serial claims would result in lower improper payments and reductions in inappropriate utilization.
  • Expands prior authorization to an expanded list of DMEPOS items that are at high risk for improper payments.

It is important to remember that the House and Senate reached a budget deal last week, and that the White House budget is essentially a series of requests to Congress, and not legislative language. Rather, it is a document designed to influence future legislative discussion.

That said, AAHomecare detailed is concerns, particularly in regards to the rural bid expansion provisions:

“With regards to the first item, the infrastructure of the HME sector is fragile enough as it is with a 40 percent decrease in providers since 2013,” the AAHomecare statement read. “ The financial pressures are felt by companies dealing with deep reimbursement cuts stemming from the competitive bidding program, the use of bidding-derived pricing in rural/non-bid areas, and through the ripple effect of other MCO payers, Medicaid and TRICARE who use these rates as a guideline. To suggest that there are an additional $6.5 billion in cuts that rural providers can absorb over 10 years, on top of the drastic cuts since 2016, is frankly incomprehensible. Access to care is severely threatened in the current Medicare reimbursement environment; there is no room for additional cuts — and, we hope, no stomach for such cuts for Senators and Representatives who will see their constituents severely impacted.

“AAHomecare and other HME stakeholders are working to assess these proposals and reach out to our Congressional and regulatory agency contacts for more information on the source and prospects for a ‘rural bidding program and the elimination of median bid pricing under CB,” the association added.

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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