WASHINGTON, DC – Rep Cathy McMorris-Rodgers (R-Wash) [pictured] released a Congressional sign-on letter to HHS Secretary Tom Price and CMS Administrator Seema Verma today asking them to use their authority to make significant changes to HME policy.
The letter, which can be seen here, asks for reforms in four key areas that echo input from AAHomecare and other stakeholders to HHS and CMS.
• Relief for Non-Competitive Bid Areas
• Reforms to the Competitive Bidding Program
• Relief for Complex Rehab Technology (CRT) Accessories
• Restore Oxygen Rates in Rural Areas
Ask Your Representative to Add His/Her Name
Champions on Capitol Hill have asked for concerted industry support for grassroots efforts to get signatures on the letter; AAHomecare officials believe that affirming Congressional interest/pressure on these issues will help provide impetus for regulatory action. If providers are able to help deliver a strong showing of 150+ signatures on this letter, it will make a powerful impression on HHS and CMS as they consider recent input on these issues from AAHomecare and other HME stakeholders.
Please contact your Representatives in the House and ask that they sign onto the letter. Please call or send an email if you have contacts in your House Member’s office; you can also send a pre-written note via our Action Center here. We will also be asking members of Congress to sign on during the upcoming Washington Legislative Conference.
Please note: this sign-on letter is for members of the House of Representatives; you should not contact Senate offices about this letter. Other original signers on the letter include Reps Lee Zeldin (R-N.Y.), Dave Loebsack (D-Iowa), Diana DeGette (D-Colo.), Larry Bucson (R-Ind.), and Marsha Blackburn (R-Tenn.).
DATA Act of 2017 (Prior Authorization) Would Help Prevent Medicare Audits for HME
WASHINGTON, DC – Congresswoman Marsha Blackburn (R-Tenn.) has formally introduced legislation that would require prior authorization for certain home medical equipment items in higher price ranges. The formal title for H.R. 2445 will be the DMEPOS Access and Transparency Act of 2017, and may also be referred to as the DATA Act of 2017.
The new legislation builds upon previous prior authorization legislation championed by Rep. Blackburn, and includes new provisions that require medical necessity for respiratory equipment. Other key provisions of the bill include (italicized text is taken directly from a final draft of the legislation):
Not later than 1 year after the date of the enactment of this subparagraph, the Secretary shall develop and implement a prior authorization process for certain durable medical equipment, prosthetics, orthotics, and supplies. A claim for an item of durable medical equipment, a prosthetic, an orthotic, or a supply that has received prior approval through the prior authorization process shall be exempt from subsequent pre- and post-payment audits and only subject to audits for systematic fraud and abuse.
The Secretary shall consider the following factors in developing and implementing the prior authorization process:
(I) Beneficiary access to timely care.
(II) Alignment with the best practices of commercial managed care plans and Medicare Advantage plans under part C that have expertise in prior authorization processes.
(III) Implementation of standard medical necessity evaluation prior authorization requests for physician and hospital referral agents and non-physician practitioners.
(IV) Accounting for same day delivery expectations by providing for expedited emergency review for certain items.
“This legislation will help stem the tide of Medicare audits that delay payments for providers and also tie up significant resources as providers answer and appeal them,” said Tom Ryan, president and CEO of AAHomecare. “We applaud Congresswoman Blackburn’s longstanding efforts to help rein in excessive audits by establishing an effective prior authorization process that will improve cash flow for providers and allow them to concentrate more resources and energy on serving their patients.”
A draft of the legislation is available here. AAHomecare will provide additional perspective on the legislation and how the HME community can support it shortly.