Moving the HME Industry Forward


Rural Relief Bill Likely This Week

May 9, 2016

WASHINGTON, DC – The long-awaited House competitive-bidding rural relief and bid-ceiling fix bill is expected to drop this week – a current working draft of the legislation can be found here; it is the House companion to S. 2736.  

The House bill has identical language, except for the pay-for provision. Because of some concern in the House, industry champions have included a placeholder pay-for to give House and Senate committees time to find an alternative.

While there have been encouraging reports from Capitol Hill offices that provider calls and emails are being heard, industry champions have asked for as much grassroots support as the HME community can muster.

If you haven’t reached out to representatives in the House, AAHomecare officials ask that you call their office with this simple request:

Please co-sponsor competitive bidding rural relief legislation expected from Reps. Tom Price (R-Ga) [pictured] and Dave Loebsack (D-Iowa); the legislation will be similar to S. 2736 which has already been introduced in the Senate – and let them know, in your own words, why you believe the next round (July 1) of bidding-derived cuts for rural and non-bid areas need to be delayed until the effects of the January 1 cuts can be fully assessed.

You can find contact information for your Representative in the AAHomecare Congressional directory. As we’ve noted in an earlier edition of AAHomecare’s Wednesday in Washington, if your representative is on the House Energy & Commerce Committee, your outreach is especially needed!

Additional resources:
• Issue brief on rural relief legislation;
• State-by-state maps showing CBAs as well as regional/non-bid and rural areas; and
Email your legislators here.

This legislation represents the best chance to get a significant delay on the next round of cuts, and to make sure CMS is properly assessing the effect of the bidding program on rural patient access. If you haven’t reached out to legislators on this issue, the time is now.

Industry Efforts Spark Vent Policy Revision in Favor of Patients
WASHINGTON, DC – As anticipated, the DME MACs collectively released revised coding and coverage requirements for ventilators in the Frequent and Substantial Servicing (FSS) payment category.

The new guidance removes the imminent death criteria from the coverage, which is now applicable under the following conditions: neuromuscular diseases; thoracic restrictive diseases; and chronic respiratory failure consequent to chronic obstructive pulmonary disease.

The announcement explains, “Ventilator technology has evolved to the point where it is possible to have a single device capable of operating in numerous modes, from basic continuous positive pressure (CPAP and bi-level PAP) to traditional pressure and volume ventilator modes. This creates the possibility that one piece of equipment may be able to replace numerous and different pieces of equipment. Equipment with multifunction capability creates the possibility of errors in claims submitted for these items.”

The announcement also discusses issues related to upgrades and conditions needed to authorize payment for a second ventilator, which can only occur in cases of medical necessity, and not for spare/back-up equipment.

AAHomecare has been actively working with members and other stakeholders in the respiratory care sector to pursue relief on ventilator clinical requirements. This revised coding and coverage is a direct result of industry, clinical groups, consumer groups, manufacturers and suppliers engaging CMS and the DME MACs to advocate for needed adjustments to the medical necessity requirements for these essential products. AAHomecare will provide further analysis upon review.