Rep. Mike Ross (D-Ark.) presented his oxygen reform legislation to the House Energy and Commerce Committee this week in the form of an amendment during mark up of the House health reform bill, H.R. 3200, America’s Affordable Health Choices Act of 2009.

Ross received assurance from Committee Chairman Henry Waxman (D-Calif.) that the two of them would work through some of the remaining questions about the amendment’s cost. With that commitment from Chairman Waxman, signaling that a vote on the amendment is not required in the Committee, Rep. Ross withdrew his amendment.

The Ross oxygen amendment is designed to be budget-neutral and not increase Medicare spending on the home oxygen benefit. If the issues with the cost can be resolved, the amendment could go to the House Rules Committee next for consideration to be included in the larger health reform legislation that would go to the House floor.

The Ross legislation has been a point of contention within the industry, which has strived to find common ground so that it can support oxygen reform with a unified front. While the industry initially spent much of the summer debating as to whether or not the Medicare Home Oxygen Therapy Act of 2009 introduced into the House by Reps. Mike Ross (D-Ark.) and Kendrick Meek (D-Fla.), various industry groups met to discuss a revised oxygen benefit reform proposal on Aug. 18 in the hopes of striking a compromise that could be incorporated into the Act. Organizations including the American Association for Homecare and the National Association for Independent Medical Equipment Suppliers convened in hopes of hammering out an oxygen reform that the entire industry could stand behind.

However, despite an agreement apparently being reached, AAHomecare President Tyler Wilson distributed an open letter to providers last week calling for them to stand united behind the Ross legislation.

The Ross amendment repeals the 36-month cap on oxygen payments, and it contains the changes to the amendment that were agreed to at an Aug. 18 stakeholders meeting. The changes incorporated into the Ross amendment include the following:

• It maintains supplier status for HME providers who furnish home oxygen therapy;
• The issue of competitive bidding will be addressed in a separate stand-alone measure instead of including it as a provision in the Ross amendment;
• The geographic adjustment provision was eliminated; and
• It would implement a cost survey to be completed by a statistically representative sample of suppliers each year rather than by all oxygen suppliers.

The one outstanding issue following the Aug. 18 stakeholders meeting was the interim payment system for the period between repeal of the 36-month oxygen cap and implementation of a new rate structure. The Ross amendment provides that the combined portable Medicare payment rate be 90 percent of the current 2009 allowable. New technology would remain at the current 2009 level. Once the 90 percent calculation is made for combined portable, concentrator-only rates would be determined in accordance with the Ross mandate that the entire payment system be budget-neutral.

During the discussion of his amendment during today’s mark-up, Ross said that the current structure of the home oxygen therapy benefit inappropriately focuses on the equipment rather than on the services provided to beneficiaries, and that the new oxygen payment structure in his amendment mirrors that applied to other Medicare providers and addresses many of the concerns historically raised about the benefit.

Congressman Ross told Committee Chairman Rep. Henry Waxman (D-Calif.) that he wanted to work with him to resolve any questions about Congressional Budget Office scores, or cost projections, regarding the oxygen amendment. Chairman Waxman replied to Ross, “Let’s work together.”