Draft Spending Bill Includes DME Provisions

As Congress now moves vote on the year-end budget package, the legislation includes language concerning key HME reimbursement objectives.

Lawmakers have drafted an omnibus spending package that extends the 75/25 blended Medicare rate for non-CBA, non-rural suppliers until at least Dec. 31, 2023, and prevents the 4 percent Medicare “PAYGO” cuts for 2023 and 2024.

The news comes after concerted outreach from HME providers, industry advocates and the American Association for Homecare, urging lawmakers to include key industry provisions in any year-end spending package. The effort went up to the last moment, with AAHomecare CEO Tom Ryan and Senior Vice President of Public Policy Jay Witter, as well as lobbyists from Prime Policy and the Nickles Group, holding meetings on Capitol Hill with legislators and staff from committees of jurisdiction regarding the various legislative items.

“This is a major win for the home medical equipment community,” AAHomecare’s Ryan said in a public statement. “The relief granted for non-rural/non-CBA suppliers, taken with the 50/50 blended rate in rural areas granted to rural suppliers by CMS in the 2021 DMEPOS Final Rule, will impact bottom lines for a large swath of the industry. Preventing potentially ruinous 4 percent PAYGO cuts on every single Medicare transaction for HME is obviously very consequential across our industry, as well.”

The bill’s HME provisions:

  • Extend the CARES Act’s 75/25 blended rates for non-CBA, non-rural suppliers through the remainder of the public health emergency or until Dec. 31, 2023, whichever is later.
  • Prevent the application of across-the-board 4 percent Medicare cuts for 2023 and 2024 that would have otherwise resulted from the 2010 “PAYGO” budget legislation.
  • Grant a two-year extension for telehealth waivers established during the COVID-19 PHE.
  • Include language from wound care legislation (H.R. 2356 and S.2363) that revises reimbursement for disposable negative pressure wound therapy devices.
  • Include language from lymphedema treatment legislation (H.R. 3630 and S.1315) that provides coverage for compression items used in the treatment of lymphedema.

However, the bill does not include one industry objective, language from H.R. 6641, which would have applied a 90/10 blended rate in former CBAs.

Still, with major objectives secured, AAHomecare’s Ryan thanked the industry’s advocates and providers for their lobbying efforts, as well as key legislative allies.

“I’m incredibly proud of the persistent grassroots advocacy that has secured these impactful, bottom-line wins for HME,” he said. “We have been working to secure and extend the 75/25 rates for several years, and this success is the result of your calls, emails, and meetings with your legislators as well as a sustained presence on Capitol Hill.”

“We also appreciate the leadership of Sen. John Thune (R-S.D.), Sen. Debbie Stabenow (D-Mich.), and Sen. Maggie Hassan (D-N.H.) for their work pushing the CARES Act relief forward during negotiations on the Omnibus bill,” Ryan added. “Their support was absolutely critical in making sure the 75/25 blended rate provisions were included in the final draft.”

Now the industry waits for the House and the Senate to upvote the spending package and for President Biden to sign it into law.

About the Author

David Kopf is the Publisher HME Business, DME Pharmacy and Mobility Management magazines. He was Executive Editor of HME Business and DME Pharmacy from 2008 to 2023. Follow him on LinkedIn at linkedin.com/in/dkopf/ and on Twitter at @postacutenews.

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