AAHomecare Sets Sights on Appropriations Committees

With IFR potentially stalled at OMB, association president calls on industry to lobby House, Senate decision-makers to support key legislative language.

• By David Kopf
• Mar 08, 2018

After pushing to help get 56 Representatives to add their signatures to a House sign-on letter, the American Association is focusing its efforts on getting H.R. 4229 language added to the final Appropriations bill, rather than advancing the Interim Final Rule on rural relief.

The IFR, which has languished at the Office of Management and Budget since August, would resume the 50/50, blended fee schedule for rural and non-bid areas that was in effect during the phase-in of national bid expansion during Jan. 1, 2016 to June 30, 2016, and apply it to claims submitted between Aug. 1, 2017 to Dec. 31, 2018. It would also exclude home infusion drugs used with HME from competitive bidding.

Up until February, industry advocates had pushed hard to enlist lawmakers to call on OMB Director Mick Mulvaney to release the IFR. Unfortunately, that hasn’t happened.

“When CMS announced that they had sent an HME-related IFR to the Office of Management and Budget in late August of last year, many in the HME community — myself included — thought we might be on the verge of getting significant relief for rural providers and helping prop up rates for other payers who use the Medicare fee schedule as a guideline,” noted AAHomecare President and CEO Tom Ryan in an update. “With the resignation of HHS Secretary Tom Price a little more than a month later, optimism for quick approval of the IFR began to fade. As we approach 200 days since the IFR was sent to OMB, and without any recent signs of urgency or forthcoming action from HHS, CMS, or OMB in support of the IFR, it’s becoming increasingly possible the IFR may never be finalized.

“While this realization is a difficult pill to swallow, it also underscores the importance of our legislative efforts to roll back a portion of bidding-derived cuts for rural providers and fixing the ‘double dip’ cuts for rural oxygen,” Ryan added.

So, knowing that 128 co-sponsors have already backed H.R. 4229, the association has pushed to get H.R. 4229’s rural relief provisions added to the next appropriations bill, which would keep the government funded. The bill’s main provisions:

• It would effectively roll back the second round of cuts for non-bid area suppliers, effective retroactively to January 1, 2017 and through 2018.
• It would address rate cuts caused by the misapplication of a 2006 budget neutrality offset balancing increased utilization for oxygen generating portable equipment with lower reimbursement for stationary equipment.

Ryan says the industry must “make a strong lobbying push aimed at decision makers on the House and Senate Appropriations Committees to reinforce the message on the recent sign-on letter to House Appropriations leaders.”

Ryan called on HME stakeholders that are represented by a member of the House or Senate Appropriations Committees to make a request to those lawmakers along these lines:

“Please include provisions from H.R. 4229, the Protecting HOME Access Act, in the next round of budget legislation.  This bill would provide relief for durable medical equipment providers in rural areas facing drastic and unsustainable Medicare reimbursement cuts and would also roll back unsustainable cuts for providers in all communities – urban, suburban, rural – who serve TRICARE and Medicaid beneficiaries.  Without this relief, we’re at risk of losing an important part of the infrastructure that serves seniors and people with disabilities and helps lessen the need for hospitalizations and other costly clinical interventions.”

As of press time, the key lawmakers in each chamber are:

House Appropriations Committee (* denotes current H.R. 4229 co-sponsor; 20 members of he committee support the bill, so far):

• Chair: Rodney Frelinghuysen (R-N.J.)
• Ranking Member: Nita Lowey (D-N.Y.)
• Robert Aderholt* (R-Ala.)
• Martha Roby* (R-Ala.)
• Steve Womack (R-Ark)
• Pete Aguilar (D-Calif.)
• Ken Calvert (R-Calif.)
• Barbara Lee (D-Calif.)
• Lucille Roybal-Allard (D-Calif.)
• David Valadao (R-Calif)
• Rosa DeLauro (D-Conn.)
• Tom Rooney (R-Fla.)
• Debbie Wasserman Schultz (D-Fla.)
• Sanford Bishop* (D-Ga.)
• Tom Graves* (R-Ga.)
• Mike Simpson (R-Idaho)
• Mike Quigley (D-Ill.)
• Pete Visclosky* (D-Ind.)
• David Young* (R-Iowa)
• Kevin Yoder (R-Kan.)
• Hal Rogers (R-Ky.)
• Chellie Pingree* (D-Maine)
• Andy Harris (R-Mary.)
• Dutch Ruppersberger* (D-Mary.)
• Katherine Clark (D-Mass.)
• John Moolenaar* (R-Mich.)
•  Betty McCollum* (D-Minn.)
• Steven Palazzo* (R-Miss.)
• Jeff Fortenberry (R-Neb.)
• Mark Amodei (R-Nev.)
• Grace Meng (D-N.Y)
• José Serrano (D-N.Y.)
•  David Price (D-N.C.)
• David Joyce* (R-Ohio)
• Marcy Kaptur* (D-Ohio)
• Tim Ryan* (D-Ohio)
• Tom Cole* (R-Okla.)
• Matt Cartwright (D-Pa.)
• Charlie Dent (R-Pa.)
•  Chuck Fleischmann (R-Tenn.)
• John Carter (R-Texas)
• Henry Cuellar (D-Texas)
• John Culberson (R-Texas)
• Chris Stewart* (R-Utah)
• Scott Taylor* (R-Va.)
• Jaime Herrera Beutler R-Wash.)
• Derek Kilmer* (D-Wash.)
• Dan Newhouse* (R-Wash.)
• Mark Pocan* (D-Wisc.)
•  Evan Jenkins* (R-W.V.)  

Senate Appropriations Committee (* denotes co-sponsorship of S. 2736, rural relief legislation in 114th Congress):

• Chair: Thad Cochran* (R-Miss.)
• Ranking Member: Patrick Leahy (D-Vt.)
• Richard Shelby (R-Ala.)
• Lisa Murkowski (R-Alaska)
• John Boozman (R-Ark.)
• Dianne Feinstein (D-Calif.)
• Chris Murphy (D-Conn.)
• Chris Coons (D-Del.)
• Marco Rubio (R-Fla.)
•  Brian Schatz* (D-Hawaii)
• Dick Durbin (D-Ill.)
• Jerry Moran* (R-Kan.)
• Mitch McConnell (R-Ky.)
• John Neely Kennedy (R-La.)
• Susan Collins* (R-Maine)
• Chris Van Hollen (D-Mary.)
• Roy Blunt* (R-Mo.)
• Steve Daines (R-Mont.)
• Jon Tester (D-Mont.)
• Jeanne Shaheen (D-N.H.)
• Tom Udall (D-N.M.)
• John Hoeven* (R-N.D.)
• James Lankford (R-Okla.)
• Jeff Merkley (D-Ore.)
• Jack Reed (D-R.I.)
• Lindsey Graham (R-S.C.)
• Lamar Alexander (R-Tenn.)
• Patty Murray (D-Wash.)
• Shelly Moore Capito* (R-W.V.)
• Joe Manchin* (D-W.V.)
• Tammy Baldwin* (D-Wisc.)

“We face another challenge in moving rural relief provisions to the top of the priority list for Appropriations negotiators over the next week or so, but we do have one important factor in our favor: thanks to your strong advocacy efforts, 20 members of the House Appropriations Committee are H.R. 4229 co-sponsors,” Ryan reminded. “Let’s build on this foundation and make a strong impression on these targets this week and next week.  We’ve come too far to let this opportunity slip by without giving it our all.”