Observation Deck

H.R. 6641’s Reimbursement Ripple Effect

Success on H.R. 6641 could have wide-ranging impacts on DME reimbursement across a spectrum of payers far beyond Medicare. It’s essential that providers help raise the visibility of the bill.

Fighting for sustainable reimbursement rates from Medicare and other major payers is a top priority for the American Association for Homecare. Without reimbursement rates that take into account higher prices for products and other increased operational costs, the HME community cannot fully realize our potential to meet the needs of the growing population of individuals who need home-based care.

Currently, we are working on two legislative initiatives to boost rates. H.R. 6641, introduced in February of this year, would apply a 90/10 blended rate for Medicare reimbursements in CBAs, which we estimate would boost reimbursements for items covered under the bidding program by 9.3 percent, on average.

For suppliers in non-rural, non-bid areas, we are working with Senate HME champions to build support for extending a 75/25 blended rate currently in effect in those areas beyond the end of the COVID-19 PHE. 

Taken with our success in continuing the 50/50 blended rate for suppliers in rural areas indefinitely, success on these two fronts would mean better, more-sustainable rates for Medicare suppliers everywhere. What’s more, securing H.R. 6641’s 90/10 blended rate for former CBAs would ripple through a broad spectrum of payers who peg their rates to the Medicare fee schedule.

Passing H.R. 6641 would also boost Medicaid and TRICARE rates that are directly tied to the Medicare fee schedule and could also impact other third-party insurers/private payers, including Medicare Advantage plans, that use Medicare rates as a factor in their rate-making. 

Helping Build the Case 

We need every HME stakeholder on board to raise the visibility of reimbursement legislation on Capitol Hill. We need every voice if we are going to stand out among the multitudes of competing legislative initiatives and political issues facing the House and Senate.

Please reach out to your House members in support of H.R. 6641. You can find details on how to make a case for this legislation at our Medicare Reimbursement Legislation Campaign Central.

In addition, if your Senator is one of 28 members of the Senate Finance Committee, your advocacy for extending the 75/25 blended rates in non-rural, non-bid areas will be critical. Look for more information on how you can support those efforts soon.

With the last two rounds of the bidding program effectively abandoned, we have a unique opportunity to make a case for Medicare reimbursement rates that reflect market reality – and to ultimately impact a wide spectrum of rates from other public and private payers. We can’t afford to miss this chance to put HME rate-making on a more sustainable footing for 2023 and beyond.

About the Author

Tom Ryan is president and CEO of the American Association for Homecare (AAHomecare.org). Prior to assuming that role in 2013, he spent 25 years as the president and CEO of Homecare Concepts, a Farmingdale, N.Y.-based respiratory company that he had founded. Follow Tom on Twitter @TomRyanHME.

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