News Feature

HME’s Bottom Line Success

AAHomecare advocacy efforts have resulted in policy and regulatory wins that have driven more than $2 billion back to HME providers’ budgets. How does the association plan to build on those wins?

The American Association for Homecare recently tabulated recent policy wins in terms of how much money they would drive back to the bottom lines of HME providers, and the result was encouraging indeed: $2 billion in federal and state policy wins for 2020 and 2021.

That said, there’s still work to be done, and the association is already lining up its efforts in that regard, according to its CEO, Tom Ryan.

But before we dive into the future, let’s learn more about that $2 billion that’s in the here and now. The figure breaks down into several key policy advancements:

  • $1.4 billion — The provider relief funds that went to HME suppliers (out of a total of $90 billion for the healthcare community).
  • $251 million — The 75/25 relief rates for non-rural areas in COVID-19 relief legislation (one year).
  • $158 million — The recently passed nine-month extension on relief from Medicare’s 2 percent sequestration cut (which lasts until Dec. 31).
  • $100 million — The efforts to prevents reimbursement cuts and carve out CRT power accessories (the total is $500 million over 10 years).
  • $70 million — Payer relations efforts to protect reimbursement rates.
  • $65 million — After much convincing from the industry, CMS announced its fee schedule for oxygen reimbursement would not apply budget neutrality (aka the “double-dip”). The change resulted in 5 percent to 11 percent increases in oxygen products across the country, which went into effect on April 1 (this also means $650 relief over 10 years).
  • $15 million — The prevented CURES paybacks.
  • $2 million — The N.C. sales tax law

This list doesn’t include the fact that, because the CARES Act extended the 50/50 blended rate, rural suppliers will continue to receive millions more in reimbursements than they otherwise would have.

Major Wins

Some of the line items on that list of wins represent hard-fought fights. AAHomecare’s Ryan emphasizes that finally getting the oxygen budget neutrality problem addressed was a pivotal win.  

“The financial impact — estimated by the CBO at $650 million over 10 years — is significant for HME respiratory suppliers,” he notes. “This is also a particularly satisfying win for the AAHomecare team and the advocacy leaders in our industry who engaged CMS and Capitol Hill for four years to get it fixed. It’s gratifying to see those persistent efforts get rewarded, and it’s also a great example of what we can achieve with a united front and the determination to keep plugging away when you believe in what you’re doing.”

Also, Ryan says convincing Capitol Hill to endorse the 75/25 blend for non-rural non-competitive bid areas for the first time by applying those through the duration of the COVID-19 Public Health Emergency (PHE) was also important as was securing the continued 50/50 blend for rural areas.  

And of course, there’s COVID-19 relief, which industry advocates had to ensure would include HME providers.

“Making sure HME was included in the provider relief fund program and receiving a substantial $1.4 billion in relief funds is substantial and helps offset impacts and costs associated with the pandemic,” Ryan says.

Future Efforts

Of course, the fight to protect HME continues. Ryan says the next focus is securing a rate adjustment for Medicare single payment amount (SPA) rates that reflect the market conditions in which HME suppliers are currently operating.

“Costs for equipment, labor, and other business expenses are increasing for many suppliers, and yet we’re saddled with reimbursement rates based on bids submitted more than six years ago,” he explains. “We need sustainable, market-based reimbursement rates; that’s priority one for us.  

“We also want to make sure that the 50/50 blended rates for rural suppliers and 75/25 rates for other non-CBA suppliers are continued if CMS doesn’t include those provisions in the latest iteration of the DMEPOS Proposed Rule,” he adds.

Also, the industry must ensure Congress prevents potential 4 percent, across-the-board Medicare cuts for the fiscal year 2022. Those cuts come from 2010 legislation that was designed to offset deficit spending increases, and the concern is that the spending required to fund the recent $1.9 trillion coronavirus relief package would result in the cuts — a strange irony, Ryan notes.

“We’re part of a coalition of major healthcare groups who are working to get those cuts waived,” he explains. “Surely, it is not Congress’ intent to finance expansive coronavirus relief through deep cuts to Medicare reimbursement rates across our entire healthcare system.”

On the state level, Ryan says the industry must build on its successes by passing more legislation that would establish Medicaid rate stability and more open networks. Currently, AAHomecare’s payer relations team is actively working to help these efforts in Florida, New York, and Oklahoma.

Getting Involved

Because these efforts are ongoing, Ryan says his association needs more HME suppliers to “join the team” that is working to secure federal and state public policy that works for HME. 

“We’re 100 percent focused on advocating for sustainable reimbursement rates, sensible regulations, and better coverage policies for HME across the full spectrum of payers,” he says. “Your personal involvement and dues dollars can help us achieve that mission even more effectively.”

A good starting point for getting involved is by joining AAHomecare’s first-ever virtual Washington Legislative Conference, a day of online meetings with Senators and Representatives that is slated for Sept. 29.

“We set up your meetings and issue education to help you make a case for HME policy priorities,” Ryan explains. “It’s a great first step in becoming more involved in HME advocacy — learn more at aahomecare.org/wlc.”

About the Author

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

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