AAHomecare Update: Challenges, Priorities and Strategy
The update from the national HME association’s panel of experts itemizes central agenda items for the industry when it comes to legislation, regulatory affairs and payer relations.
- By David Kopf
- Oct 27, 2022
On Tuesday, the American Association for Homecare hosted its AAHomecare Update during Medtrade East at Atlanta’s Georgia World Congress Center, and touched on a variety of topics, including legislative affairs, regulatory affairs and payer relations.
Kicking off the event was association President and CEO Tom Ryan, who introduced the panel discussion, and also named the 2022 Van Miller Homecare Champion award recipient (read more about the award). Then Ryan touched on various top-level issues impacting HME, with the prevailing item being reimbursement rates that are essentially frozen at 2015 levels.
While a number of factors are hitting providers at once — the Covid-19 pandemic, inflation, supply chain issues, workforce shortages — they are all compounded by insufficient revenue left over from a currently inoperable competitive bidding program.
“That program failed, yet we left those prices in place,” he says. “Today, in 2022, in a pandemic world … that’s really challenging.
“And even though we’ve seen a CPI increase of 5 percent in competitive bidding areas and an increase of, I think, 5.1 percent in other areas, that doesn’t do it,” he added.
Ryan said that while the industry did get one fix with the 50-50 blended rate, it had to get it from the Hill rather than CMS. He noted that more work is happening legislatively because the industry and AAHomecare have developed solid relationships with various legislative contacts and champions.
To that end, AAHomecare Senior Vice President of Public Policy Jay Witter said one of the legislative issues the association is “laser-focused” on is H.R. 6641. H.R. 6641 would apply 90/10 blended Medicare reimbursement for items in the 13 product categories CMS did not award contracts for in Round 2021 of competitive bidding. The increased rates would apply to claims from Jan. 1 to Dec. 31, 2023.
“Items in competitive bidding areas, which were Covid hot spots, never really received any Covid relief because of the whole bid program being paused,” he explained. “So, we worked with our champions on this legislation and we are actively seeking for it to be a part of the end-of-the-year package.”
Witter said its contacts on the Hill are expecting the 117th Congress will close 2022 with an omnibus legislative package that could support the bill’s provisions. The key is to drive co-sponsors for the bill before that time.
Other policy priorities Witter mentioned included a Senate effort that would extend the CARES Act relief for providers in the non-competitive bidding areas. This includes a 50-50 blended rate for rural areas and a 75-25 rate for non-rural, non-bid areas. The legislation would extend the 75-25 relief a year or two (or perhaps longer) after the PHE ends, he added. (CMS extended the 50-50 rate until the next round of competitive bidding, whenever that might be.)
Other topics Witter discussed included the impact of the elections on the industry’s legislative agenda and the importance of providers being involved in industry advocacy and legislative outreach.
On the regulatory front, Kim Brummett, AAHomecare’s senior vice president of Regulatory Affairs led her discussion with the fact that competitive bidding remained in a holding pattern and what that meant for providers.
“We’ve had some serious conversations with some senior folks, Jason Bennett [director of CMS’s Technology, Coding, and Pricing Group] and the team at CMS,” she said. “We don’t get the sense from them that it is a priority. I think they’re unraveling all the waivers they had to put into place [due to the PHE].
“The odds of 2024 happening are low," she said. "Based on historical tracking, they’ve missed every deadline for 2022 that they would have had to put into place,” she added.
Brummett noted that AAHomecare is getting the sense that CMS wants to change the program via rulemaking, given that it was unsatisfied with the last round of the bid program. As readers might recall, CMS opted not to award contracts for 13 categories because it did not achieve the savings that it expected.
“We might see a rule for the end of 2023, but if I were a betting person, I would say 2024 is entirely not likely,” Brummett said.
Other regulatory topics Brummett discussed included: CMS’s recently announced a change to the National Supplier Clearinghouse and whether suppliers need to be concerned; CMS oxygen NCD and its change request to the MACs; and the return of Medicare claims audits and how they will impact suppliers.
Laura Williard, vice president of Payer Relations for AAHomecare, highlighted how HME should approach the Medicare Advantage environment.
“We’ve known Medicare fee for service pretty well,” she explained. “We have had experts in this for many years. Now we’re trying to learn the landscape and the rules and the regulations that are out there and what we’ve found is that there’s not a lot of protection for providers.”
Williard said the industry needs better oversight in Medicare Advantage and an ombudsman or liaison that can help the industry with issues concerning those plans. She also noted that CMS has the oversight to change rules related to Medicare Advantage.
“Really, I hear it every day: ‘We don’t know where to go and we don’t know what to do next,’” she said. “We need that resource at CMS to help us.”
Other payer relations topics included what 2023 will look like for Medicaid programs now that the end of the Covid-19 PHE is looming; new resources to help providers in payer contract negotiations; 2023 state legislation; and vertical integration within the payer landscape.
David Kopf is the Publisher and Executive Editor of HME Business and DME Pharmacy magazines. Follow him on LinkedIn at linkedin.com/in/dkopf/ and on Twitter at @postacutenews.