The U.S. House Energy & Commerce Health Subcommittee has approved H.R. 5555 and H.R. 5371, which now move to the full Energy & Commerce Committee for consideration.
In a Nov. 14 announcement, the American Association for Homecare (AAHomecare) described the two bills — the DMEPOS Relief Act of 2023 (H.R. 5555) and the Choices for Increased Mobility Act of 2023 (H.R. 5371) — as “priority measures.”
Tom Ryan, President/CEO of AAHomecare, said in the announcement, “This is a major step forward for our priority legislation in the House. The HME community’s persistent grassroots advocacy and three separate legislative events, including Monday’s Virtual Hill Day, have raised the visibility of both our policy priorities and our important role in the healthcare continuum.”
Ryan added that several legislators mentioned receiving input from home medical equipment suppliers on H.R. 5555. “It’s clear we’re making a difference here, but we’ll need to keep the pressure on to make sure we have strong buy-in across the full Energy & Commerce Committee and other influential legislators in House and Senate throughout the remainder of the year,” he said. “I’m confident HME advocates are ready to do what it takes to bring home some wins for our industry.”
H.R. 5555: Supporting a Large Range of DME Suppliers
When H.R. 5555 was introduced in September by Rep. Mariannette Miller-Meeks (R-Iowa) and Rep. Paul Tonko (D-N.Y.), AAHomecare described the bill as “new legislation providing relief for suppliers across a broad range of patient segments.”
The bill would provide a blended 90-percent adjusted payment rate/10-percent unadjusted fee schedule rate for most home medical equipment products in Competitive Bidding Areas (CBAs), starting Jan. 1, 2024, and continuing throughout the year.
H.R. 5555 would also extend the current 75/25 blended rate now in effect for non-rural/non-Competitive Bidding Area suppliers through 2024.
As part of that September announcement, Ryan said, “This legislation provides a long-overdue relief for HME suppliers serving Medicare beneficiaries in CBAs, who have been saddled with reimbursement rates that have not seen a meaningful, market-based adjustment since 2015. These modest rate increases will help stabilize the HME supplier base and provide better access to high-quality home-based care for millions of Americans and their caregivers.”
H.R. 5371: Advocating for Consumer Freedom of Choice
H.R. 5371 provides a path for Medicare beneficiaries to pay out of pocket to upgrade to a titanium or carbon fiber frame for their ultralightweight wheelchairs. Currently, Medicare does not allow beneficiaries to choose to upgrade, even though upgrades doesn’t cost Medicare a cent.
Instead, beneficiaries who want a titanium or carbon fiber frame must pay out of pocket for the entire wheelchair, and then wait for partial Medicare reimbursement. Consumer advocates have protested that relatively few wheelchair riders can afford to pay the cost of an entire wheelchair up front.
While lighter weight is often used to argue for a titanium or carbon fiber frame over the “standard” ultralightweight aluminum frame, Assistive Technology Professionals (ATPs) have long contended that titanium and carbon fiber offer additional functional advantages, including improved vibration dampening, greater strength, and greater durability.
In supporting H.R. 5371, NCART said, “On December 15, 2016, Durable Medical Equipment Medicare Administrative Contractors released a policy that prohibited upgrades for titanium wheelchairs, which prevents suppliers from billing a Medicare beneficiary for an upgrade to their wheelchair. As a result, the only avenue for a Medicare beneficiary to obtain a titanium or carbon fiber wheelchair is to pay for the entire wheelchair out of pocket and for the supplier to file a non-assigned claim to CMS [Centers for Medicare & Medicaid Services] for partial reimbursement. This has had a significantly negative impact on access to titanium and carbon fiber wheelchairs for individuals with complex medical needs.
“Individuals with disabilities should have the choice to pay for a titanium or carbon fiber upgrade to their manual wheelchair. On Sept. 8, 2023, Rep. John Joyce [R-Pa.] introduced the Choices for Increased Mobility Act of 2023, which would enable beneficiaries to privately pay for upgrades to their equipment by removing the current obstacles in place and offering key benefits to end users at no additional cost to CMS.”