House Sign-on Letter Asks for More Relief in CMS’s Proposed Rule

Providers called on to lobby lawmakers to sign a letter asking CMS to expand relief for HME providers in its proposed ESRD/DMEPOS rule.

Rep. Cathy McMorris Rodgers (R-Wash.) has introduced a House sign-on letter asking the leadership of CMS, HHS, and OMB to expand the relief for HME stakeholders provided in CMS’s proposed ESRD/DMEPOS rule, and industry leaders are calling on providers to help drive Congressional support for the letter.

In the letter, available at bit.ly/2Dj3Ilf, Reps. McMorris Rodgers, Brett Guthrie (R-Ky.), Dave Loebsack (D-Iowa), and Diana DeGette (D-Colo.) — as well as any additional signers — acknowledge various policies in CMS’s proposed rule that help counteract previous policy and regulatory changes that “resulted in substantial reductions in reimbursements.” However, the proposed rule doesn’t go far enough, according to the letter’s signers.

“We urge you to continue to work with Congress, stakeholders, and auction experts to make further reforms and refinements to ensure the bid program derives market-based reimbursement rates, while protecting beneficiaries’ access to durable medical equipment,” the letter reads.

The letter calls on CMS to make three specific changes:

1. Raise the reimbursement rates in CBAs during the gap period. The proposed rule would let beneficiaries get HME items from any Medicare-enrolled DMEPOS provider from Jan. 1, 2019 until new contracts are awarded for the next round of the bidding program. In the rule, CMS suggests applying the current competitive bidding single payment amounts (SPAs), plus an inflation index, in the former competitive bid areas, until the next round of bidding can be implemented.

“Since CMS has recognized these SPAs are deficient due to the bid program’s median price methodology, we are concerned that these rates are inadequate, particularly when there no longer remains the increased market share that was the balancing rationale for the lower bid prices in the first place,” the letter notes. “We urge you to increase the reimbursement rates in competitive bidding areas in the period before the next round of bidding is implemented.”

2. Extend “rural relief” to all non-Competitive Bidding Areas. The proposed rule would extend the 50/50 blended rate reimbursement rates for rural and non-contiguous areas (Alaska, Hawaii and U.S. territories) provided in CMS’s May IFR through Dec. 31, 2020. The letter calls on CMS to extend that to continuous non-bid areas, as well.

“In the 21st Century Cures Act, Congress recognized the access issues caused by the reductions in reimbursement and provided relief to all non-competitive bidding areas (P.L. 144-255 sections 16007 and 16008),” the letter notes. “We urge you to provide the 50/50 blended rate to all noncompetitive areas until the end of 2020.”

3. Improve access to liquid oxygen. The proposed rule also includes various changes that would ensure that all new payment for oxygen and oxygen equipment added since 2006 are budget neutral. However, the letter calls on CMS to undertake a more comprehensive effort to modernize its Medicare oxygen policies, including those for liquid oxygen, to ensure beneficiary access.

Push to Add Lawmakers

The Congressional letter follows an intense industry campaign to file public comments on the proposed rule. While CMS is reviewing those comments, the push is now on for providers to contact their lawmakers to sign onto the letter by Sept. 28, said Tom Ryan, president and CEO of the American Association for Homecare.

“Our champions on Capitol Hill have asked for concerted industry support for grassroots efforts to get signatures on the letter,” Ryan noted. “This may be our last opportunity to help improve this Proposed Rule and help improve reimbursement rates for our industry over the next few years. In addition, our contacts at CMS have told us that input from Capitol Hill will still be considered in shaping the regulation, even though the public comment period has passed.

To help providers get their lawmakers’ support, AAHomecare has created a pre-written note they can send via the association’s Action Center.

About the Author

David Kopf is the Editor of HME Business.

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