Moving the HME Industry Forward

Legislative/Advocacy

New ESRD Rule Under Review

May 6, 2018

WASHINGTON, DC – Last week, the Office of Management and Budget published that the proposed rule CY 2019 Changes to the End-Stage Renal Disease (ESRD) Prospective Payment System, Quality Incentive Program, Durable Medical Equipment, Prosthetics, Orthotics, and Supplies was under review.

The most recent iteration of this rule, which is statutorily mandated each year to address ESRD rates, did not include any DME-related provisions when it was finally released to the public in late June 2017. The 2016 edition of the rule included several items related to future DME competitive bidding rounds, including changing the bid ceiling to the unadjusted 2015 Fee Schedule, a provision for lead item bidding for certain product categories, and requirements for bidders to obtain surety bonds for each CBA associated with their bid.

While there is no guarantee that DME-related provisions will be included in the 2019 ESRD rule, this next round could be a vehicle for structural reforms for the bidding program that AAHomecare has advocated for with this Administration, as well as for setting a date for the next bidding round to take place.

Given the consistent release schedule for the ESRD rule in previous years dating back to 2014, we should expect to see the proposed rule in late June, with a final rule published in late October.  AAHomecare is working to find out more about the proposed rule and will report any additional developments.

Stakeholders Join Forces to Prevent Expansion of CB to Ostomy & Urological

WASHINGTON, DC – United Spinal Association, United Ostomy Associations of America, and Spina Bifida Association partnered with AAHomecare on a comprehensive White Paper to articulate why Competitive Bidding should not include urologicals and ostomy supplies. The White Paper counters recent references to expanding the controversial bid program in the President’s Budget and MedPAC recommendations.

Spearheaded by the AAHomecare Medical Supplies Council, the white paper explains the complexity and diversity of the product categories, how specific products are selected in order to meet each individual’s medical and functional needs, and the risks of commoditization and reduced patient access under the Competitive Bidding Program with limited program savings potential.

“The danger of expanding the Competitive Bidding Program to ostomy and urological supplies is that the minimal function of the product can take precedent over patient choice and advanced technologies which often, and necessarily, enhances quality of life,” explains Anna Markiewicz of Hollister, a contributor to the stakeholder effort.

The paper points to CMS’ own evaluation of the ineffectiveness and inappropriateness of urological supplies in the Competitive Bidding Demonstrations in Polk County where CMS concluded, “We believe that the product category of urological supplies is not as well suited for Competitive Bidding.”  CMS reported negative impacts on quality, access, and support as well as the restricted availability of product selection under Competitive Bidding. Fundamentally, these products would not meet the original objectives of the program to save the government and taxpayers money.  CMS reported, “Urological supplies has much lower allowed charges than [other] product categories, so they offer relatively little potential for program savings.”

Find the White Paper here. To learn more about the Medical Supplies Council and its initiatives, contact Ashley Plauché, AAHomecare’s manager of government affairs, at ashleyp@aahomecare.org.

Continuing Efforts to Limit CURES Medicaid Cuts

WASHINGTON, DC – AAHomecare continues to work with state/regional associations and in conjunction with NCART, VGM, and other industry stakeholders to minimize the impact of the roll out of the Medicaid provision of the 21st Century Cures Act which limits the Federal Financial Portion states will receive beginning January 1, 2018 on a subset of 244 DME HCPCS codes.

AAHomecare has met with 21 total state Medicaid programs since December 2017 to educate and partner with them to ensure that states are in compliance with the legislation while maintaining sustainable reimbursement and patient access for these services.

As of May 2, 2018, a total of 11 states have indicated they will be changing their fee schedules to Medicare rates.  These include Vermont, Montana, Washington, Colorado, Iowa, Kentucky, North Dakota, Connecticut, Maine, Massachusetts, and Alabama.  AAHomecare and state associations are currently working with Iowa, Kentucky, Connecticut, and Alabama to reverse their decision or limit it to a smaller amount of HCPCS based on their utilization.

Twelve states have indicated that they will not be changing rates at this time: Florida, Georgia, Hawaii, Michigan, Minnesota, North Carolina, Ohio, Pennsylvania, South Carolina, Tennessee, Texas, and Indiana.

Ten states are still analyzing their data with CMS and/or AAHomecare to develop their response. These are New Hampshire, Illinois, New York, Kansas, Missouri, Oklahoma, Rhode Island, Wisconsin, Nebraska, and South Dakota.

“It’s gratifying to work alongside so many dedicated individuals across the country to encourage state Medicaid officials to take a careful look at their options for complying with the CURES Medicaid provisions,” said Laura Williard, AAHomecare’s vice president for payer relations.  “The persistence and a team-approach exhibited by these leaders has made all the difference in our successes thus far. The state Medicaid programs have been open to meeting with AAHomecare and stakeholders and are appreciative of the partnership to comply with CURES.”