The ITEM Coalition has sent a letter to Congressional leaders in support of the reinstatement of the Medicare 75/25 blended reimbursement rate for home medical equipment.
In a Dec. 2 letter, the ITEM Coalition noted that the expiration of the 75/25 reimbursement rate in January has hurt patient access to durable medical equipment (DME) nationwide.
“These cuts are derived from the DMEPOS competitive bidding program (CBP), which, according to ITEM Coalition member AAHomecare, fails to reflect the current market costs of providing care,” the letter said. “Without action from Congress or the Centers for Medicare & Medicaid Services (CMS) to provide relief from the unsustainable nature of these reductions in reimbursement, many DMEPOS suppliers and providers will not be able to remain viable, and millions of Americans with disabilities will be at high risk of diminished access to care.”
The letter was submitted to Senate Majority Leader Chuck Schumer (D-N.Y.); Senate Minority Leader Mitch McConnell (R-Ky.); Speaker of the House Mike Johnson (R-La.); House Minority Leader Hakeem Jefferies (D-N.Y.); Rep. Cathy McMorris Rodgers (R-Wash.), chair of the House Energy & Commerce Committee; Rep. Frank Pallone (D-N.J.), ranking member of the House Energy & Commerce Committee; Sen. Ron Wyden (D-Ore.), chair of the Senate Finance Committee; and Sen. Mike Crapo (R-Idaho), ranking member of the Senate Finance Committee.
The coalition also voiced “long-standing concerns” about competitive bidding and the contention that the program has limited access to HME over the years, has limited equipment choice, and has therefore reduced quality of care.
“In 2018, CMS paused the CBP because of design flaws that caused unsustainable payment rates resulting in access issues for Medicare beneficiaries who need DMEPOS services,” the letter said. “CMS used the two-year pause to redesign the program.”
In the years that followed, however, HME providers continued to be reimbursed at outdated rates, Coalition members said. “Unfortunately, CMS maintained the previously flawed payment rates that were established in 2016 during the pause, which were 50-60% lower than the unadjusted Medicare fee schedule rates. Congress and CMS have intervened numerous times through the years to
provide additional relief, most recently providing a 75/25 blended rate for non-bid, non-rural
areas through 2023 (75% competitive bid rate/25% unadjusted Medicare fee schedule rates).
“While not ideal, this 75/25 blended rate was a much-needed lifeline for DMEPOS suppliers and providers, and afforded beneficiaries continued access to the level of care and services that they needed.”
When the 75/25 blended rate expired on Jan. 1, the result was “a 20% fee reduction across the top 25 DME HCPCS codes, dealing a crushing blow to DMEPOS suppliers and providers, threatening to decimate the infrastructure that enables Medicare beneficiaries with disabilities and chronic conditions to manage their medical and functional needs at home.”
The letter urged support for bills in the House and Senate to “provide relief from the devastating impact that these reimbursement reductions are creating across the country.”
Coalition members referred to H.R. 5555, the DMEPOS Relief Act, “which would provide a 90/10 blended Medicare reimbursement rate (90% adjusted payment rate/10% unadjusted fee schedule rate) for most home medical equipment products in competitive bidding areas. This bill would also extend the 75/25 blended rate that expired in January for non-rural/non-CBA [non-competitive bid area] suppliers and providers for a specified length of time.”
The letter also referenced S. 1294, the Competitive Bidding Relief Act, “which would extend the 75/25 blended Medicare reimbursement rate for suppliers in non-rural, non-CBAs through a specified length of time. While these are not companion bills, provisions from each bill would help ameliorate the negative impacts of this situation going forward.
“The ITEM Coalition respectfully urges both House and Senate leadership to include provisions from these bills in any legislative package that moves prior to the end of the 118th Congress in order to preserve and protect access to affordable, timely and quality home medical equipment for Medicare beneficiaries.”
The ITEM Coalition comprises more than 30 advocacy organizations that support people living with disabilities, including the American Association for Homecare (AAHomecare), the ALS Association, the Amputee Coalition, the Association of Rehabilitation Nurses, the Brain Injury Association of America, the Christopher & Dana Reeve Foundation, the Clinician Task Force, the International Registry of Rehabilitation Technology Suppliers (iNRRTS), the National Coalition for Assistive & Rehab Technology (NCART), the Rehabilitation Engineering & Assistive Technology Society of North America (RESNA), and United Spinal Association.
