ESRD/Competitive Bidding Rule Could Hit Mid November

Rule currently at OMB; AAHomecare’s Ryan says bidding gap opens window of opportunity to drive more bid reforms.

After receiving hundreds of public comments, CMS’s proposed ESRD/DMEPOS rule is now with the Office of Management and Budget and a final rule will likely be released mid-November, according to the American Association for Homecare.

Speaking to attendees of Tuesday morning’s Washington Update at the Oct. 15-17 Medtrade conference and expo, AAHomecare President and CEO Tom Ryan said the proposed rule also provided the opportunity to push for additional reforms:

  • Raise the reimbursement rates in CBAs during the bidding gap period.
  • Extend rural relief to all non-Competitive Bidding Areas
  • Improve access to liquid oxygen.

“I received many calls saying, ‘This is the best position we’ve been in for a long time,’” Ryan said. “I said, ‘Well, it’s not perfect by any means.’ In some respects they stopped a broken program — and they admitted it’s a broken system. They admitted that median bids didn’t work. They admitted there are access issues. But guess what? They’re going to put it on hold for two years, and we’re going to hang onto those same rates. That just doesn’t make any sense to me.”

Increasing Reimbursement During the Bid Gap

Where raising reimbursement in the CBAs during the bidding gap is concerned, Ryan noted that CMS’s proposed rule lets beneficiaries source 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.

However, CMS has already acknowledged the SPAs are insufficient due to the bid program’s median price methodology, and now that no providers will be holding contracts, there won’t be enough market volume to sustain all the providers in the various CBAs. So CMS must raise the reimbursement, Ryan said.

“Now we want to hopefully increase the rates during the gap period that starts on Jan 1, 2019,” Ryan said. “We’re talking about going from the 2013 CPI-U [consumer price index for all urban consumers] and compounding another 8.7 percent. It’s not terrific, but it’s something. We have to get that relief.”

Extending Rural Relief

CMS’s 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. Ryan said the two years of additional relief is good, but CMS should extend that to contiguous non-bid areas (i.e., states in the continental United States), as well.

If so, that could drive additional funding back to those providers similar to the $350 million that the IFR put back into the industry, which was a “significant win,” Ryan said.

Improving 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, Ryan said a severe access issue to liquid oxygen still remains. Also, he said that CMS also needs to modernize all of its oxygen benefits and policies.

“There’s an omission in the proposed rule, and we went on record and said, ‘yes we agree,’ that the whole oxygen program needs to be looked at and redone.”

Ryan also reminded the Washington Update attendees that providers’ grassroots efforts have helped the industry score important incremental wins such as the IFR and the proposed ESRD/DMEPOS rule. He said that providers need to keep pushing for additional reforms and the staff and members of AAHomecare will work to make those reforms reality.

“We’ve had some wins,” he said. “That’s terrific. The past is your lesson. The present is your gift. The future is your motivation. This team is motivated, I can tell you. We’re motivated to get some more wins.”

About the Author

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


Fri, Oct 19, 2018 Bill Baker RRT Arizona

We yesterday got orders for a patient we were told was not able to qualify for oxygen, 90% SpO2, she had two drainage procedures of 1500cc of fluid from her thorax as a result of breast cancer invading her lungs and chest. The 90% SpO2 is the picture of a strong patient struggling to stay alive, not showing the respiratory rate, pulse rate, work of breathing to attain this 'number' of 90% - the reality is she couldn't sleep, couldn't walk, couldn't toilet, couldn't eat, a very distraught and struggling patient, but she can't qualify for oxygen?!!!! I think this is criminal ! Who made these rules ? Oh she's not in a chronic stable state. Absurd, her soon to be stable state will be death. She was forced to pay for oxygen "out of pocket'!!! The SYSTEM ISN'T JUST BROKEN IT'S NON-FUNCTIONAL!

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