Multiple segments within the home medical equipment (HME) industry expressed disappointment at being left out of the late December spending bill that will fund the federal government through mid March.
While the National Coalition for Rehab & Assistive Technology (NCART) lauded one bright spot — telehealth flexibilities for physical and occupational therapists “have been extended through March 2025,” the organization said in a Jan. 3 bulletin — several other segments within HME lamented that the short-term spending bill missed opportunities to improve patient access and outcomes.
No restoration of 75/25 relief rate
The American Association for Homecare (AAHomecare) reported on Dec. 18 that the end-of-year spending bill would not include the restoration of the Medicare 75/25 blended relief rate for providers. That rate expired in January 2024.
Despite what AAHomecare described as “tremendous support” for relief for HME providers, “the House and Senate negotiations regarding the health-care section of the package were very contentious. In the end, negotiators could not reach an agreement on the DME relief, and the 75/25 provisions were not included in the final bill.”
AAHomecare added that the association would again be discussing the urgent need for provider funding relief with the incoming Congress.
“The new Congress and administration can provide good opportunities to modernize the DME benefit, including the 75/25 relief measures and improving rates in competitive bidding areas, as well as moving ePrescribing forward,” AAHomecare’s announcement said. “We will again work to educate legislators from both parties in the next session, but one early lesson from this year’s experience is that we need to identify and mobilize more constituents of House Democrats to share their challenges with their Representatives.”
No pharmacy benefit manager reform included in the bill
National Community Pharmacists Association (NCPA) CEO B. Douglas Hoey said in a Dec. 20 announcement that Congress “fumbled a chance” to include pharmacy benefit manager (PBM) reform in the bill.
“We are extremely disappointed,” Hoey said. “PBM reform would rein in the big health insurance lobby, save taxpayers $5 billion, and throw a lifeline to the thousands of small, family-owned pharmacies that are on the brink of closure.
“PBM reform is supported by majorities in both parties, by outgoing President Biden, and by incoming President-elect Trump. It may be the only issue in Washington that they agree on. Every day they delay reform, another small pharmacy will close, or be pushed closer to edge, because of the business practices of big health insurers and their PBM henchmen.”
Hoey emphasized that PBM reform should be a national priority as a new year begins. “We strongly encourage our many champions in Congress to make PBM reform an immediate priority,” he said. “We encourage them to pass the health provisions as a stand-alone bill, so they don’t get buried under another mountain of spending provisions that can’t pass. They should do this as soon as possible in 2025.”
No improvement for home infusion access for Medicare beneficiaries
Similarly, the National Home Infusion Association (NHIA) expressed “deep concern” in a Dec. 17 press release about the spending bill, “which includes major changes to the qualifying criteria for drugs under Medicare’s home infusion benefit, but fails to address the underlying flaws that have plagued the program. Without fixing the structure of the benefit, Medicare beneficiaries in need of home infusions for treatment of a variety of medical conditions, including rare diseases, are unlikely to gain access to home-based care.”
“The current home infusion benefit under Medicare is an outlier compared to the well-established commercial model and has failed to engage providers or patients,” said NHIA President/CEO Connie Sullivan, BSPharm. “Expanding the list of eligible drugs without fixing these systemic barriers will result in less access than exists today.”
In that Dec. 17 press release, NHIA urged Congress to support the Preserving Patient Access to Home Infusion Act, which was referred to the subcommittee of health that day.
As a new Congress gets underway, NHIA is keeping up the pressure to optimize Medicare’s home infusion therapy benefit, which “has failed to achieve its promise of delivering patient access to home infusion. According to CMS [Centers for Medicare & Medicaid Services], several U.S. states haven’t registered a single home infusion service visit. The same report found that less than 1,500 Medicare beneficiaries are receiving home infusion services each calendar quarter — and provider participation in the benefit has steadily declined since implementation.
“Congress needs to act swiftly to rectify the situation, or beneficiaries are likely to find their home infusion options under Medicare are not what they expected,” the announcement said. “NHIA stands ready to continue our work with Congress to prioritize a fix to Medicare that meets the needs of America’s seniors and people with disabilities who rely on access to life-sustaining IV therapies.”
