Welcome
Great analogy for the DME industry: Lucy, Charlie Brown and the football Our bills The DME Industry Congress
Industry Focus Competitive Bidding Post Election Focus Intermediate Competitive Bidding Long Term Competitive Bidding-Nationwide Rollout in 2016 State Licensure Vent Legislation Infusion Legislation Grassroots Efforts Beneficiary Awareness and Mobilization
Competitive Bidding Fixes Short term: Post Election Efforts working to retro reimbursement back to pre-july 2016 rates. Intermediate term: Binding Bid language has been signed into law that holds bidders accountable for the bid that they place. The implementation date of this change is problematic, but correction language is a simple fix that we will be working towards fixing later this year. Long term:, The Medicare DMEPOS Market Pricing Program will change the process to a true auction system which economists and auction experts have strongly embraced. Congressman Tom Price (R-GA) has introduced this legislation in past sessions of Congress, but now with providers engaging their members of Congress it is progressing well.
Short Term-Rural Rollout Reimbursement Cuts in Non-CB Areas After Election Efforts S.2736 H.R.5210 Year end omnibus bill
FOIA Data on DME Suppliers
FOIA Data on DME Suppliers
CBA: Miami, FL Competitive Bid Area CB Beneficiary Impacts HCPCS Code HCPCS Code Description Definition of a Bidding Unit 2008 Bid Limit Fee Schedule: (Bid amount must be at or below this amount) 2008 Allowed Units (Number of bidding units for the CBA and HCPCS code paid by Medicare in CY 2008) 2008 Beneficiary Count (Number of unique Medicare beneficaires in the CBA that received the product in CY 2008) E0143 Walker, Folding, Wheeled, Adjustable or Fixed Height Purchase of New Item $ 102.28 14,152 14,148 2014 Bid Limit 2014 Allowed Units 2014 Beneficiary Count E0143 Walker, Folding, Wheeled, Adjustable or Fixed Height Purchase of New Item $ 108.12 10,999 10,998 2016 Reimbursment as of July 1, 2016 is: $5.26 per month (RENTAL) -3,153-3,150 HCPCS Code HCPCS Code Description Definition of a Bidding Unit 2008 Bid Limit Fee Schedule 2008 Allowed Units 2008 Beneficiary Count E1390 Oxygen Concentrator One month rental $ 175.79 203,308 16,524 2014 Bid Limit 2014 Allowed Units 2014 Beneficiary Count E1390 Oxygen Concentrator One month rental $ 108.92 69,504 9,942 2016 Reimbursment as of July 1, 2016 is: $94.08-133,804-6,582 CBA: Kansas City, MO Competitive Bid Area HCPCS Code HCPCS Code Description Definition of a Bidding Unit 2008 Bid Limit Fee Schedule: (Bid amount must be at or below this amount) 2008 Allowed Units (Number of bidding units for the CBA and HCPCS code paid by Medicare in CY 2008) 2008 Beneficiary Count (Number of unique Medicare beneficaires in the CBA that received the product in CY 2008) E0143 Walker, Folding, Wheeled, Adjustable or Fixed Height Purchase of New Item $ 108.81 4,906 4,909 2014 Bid Limit 2014 Allowed Units 2014 Beneficiary Count E0143 Walker, Folding, Wheeled, Adjustable or Fixed Height Purchase of New Item $ 115.02 1,512 1,511 2016 Reimbursment as of July 1, 2016 is: $5.43 per month (RENTAL) -3,394-3,398 HCPCS Code HCPCS Code Description Definition of a Bidding Unit 2008 Bid Limit Fee Schedule 2008 Allowed Units 2008 Beneficiary Count E1390 Oxygen Concentrator One month rental $ 175.79 92,121 10,460 2014 Bid Limit 2014 Allowed Units 2014 Beneficiary Count E1390 Oxygen Concentrator One month rental $ 180.92 37,902 5,096 2016 Reimbursment as of July 1, 2016 is: $95.02-54,219-5,364
Short Term: Competitive Bidding/Expansion to Non-Bid Areas S.2736 Patient Access to Durable Medical Equipment introduced by Sen. Thune (R-SD) and Sen. Heitkamp (D-ND) This bipartisan, non-controversial, and budget-neutral bill will: Delay the second cut for HME items in non-bid areas by 12 months. This would push back the second cut from July 1, 2016 until at least Oct. 1, 2017. Replace the bid ceiling for future rounds of bidding with the unadjusted fee service rates from January 1, 2015 instead of CMS current plans to limit future bid ceilings to the previous bid rates. Require CMS to solicit stakeholder input and take into account travel costs, volume, clearing price and information on the numbers of providers serving bid areas as part of rate-setting activities for Jan. 2019 and beyond. Require CMS to monitor and report on access issues and health outcomes for Medicare beneficiaries utilizing HME, with updates provided on the CMS website on a monthly basis. Advance the start date of the federal portion of Medicaid reimbursement mirroring Medicare rates by three months from calendar year 2019 (Jan. 1) to fiscal year 2019 (Oct 1, 2018). 35 Co-sponsors
Short Term: Competitive Bidding/Expansion to Non-Bid Areas H.R. 5210 Patient Access to Durable Medical Equipment Act of 2016 PADME introduced by Rep. Tom Price (R-G) and Rep. Dave Loebsack (D-IA) Extension of the phase-in rate of 50 percent of the previous fee schedule rate and 50 percent of the new competitively bid rate until October 1, 2017. There would be no additional cuts to DME providers in rural areas until October 2017. Adjustment of the bid ceiling set by the Competitive Bidding Program by setting the bid ceiling at the FY 2015 fee schedule rate and adjusting it for inflation. This eliminates the artificial ceiling from the previous round of bidding, which has a continuous downward pressure on prices. Requirement of CMS to consider and account for the different business models of noncompetitively bid areas (CBAs) such as the travel distance, costs associated with furnishing DMEPOS items and services within a region, the highest amount bid by a supplier that was awarded a contract and the number of providers in CBAs compared to the number of providers in non-cbas for future payment rates. Requirement of CMS to publish a monthly report of the results to allow Congress to monitor in order to ensure that Medicare beneficiaries are not adversely impacted by CMS regulations. 121 Co-Sponsors
Frontier Community Health Integration Project Demonstration (FCHIP) CMS is conducting a new demonstration program called the Frontier Community Health Integration Project Demonstration (FCHIP) which focuses on ten Critical Access Hospitals in Montana, Nevada, and North Dakota. Addresses: Ambulance Services, Skilled Nursing Facilities, Telehealth and Home Health Enhanced payment rate will be provided to account for the costs to travel extended distances to deliver home health services to patients. DME is not included
Recently introduced Ventilator Bill S.3195 and H.R. 6012 Sen. Bill Cassidy (LA) Sen. Chuck Grassley (IA) This bill will: Rep. Larry Bucshon (IN) Will require Medicare to increase the rate of payment for ventilators by 20 percent. Develop and implement clear evidence-based medical necessity standards for defining when prescribing a ventilator is reasonable and necessary.
Home Infusion Therapy Legislation Providing home infusion therapy involves not only the delivery of medication, but also requires professional services, specialized equipment and supplies to ensure safe and effective administration of the therapy. While most infusion drugs may be covered by the Medicare Part D prescription drug benefit, the Centers for Medicare & Medicaid Services (CMS) has determined that it does not have the authority to cover the infusion-related services, equipment and supplies under Part D. In Medicare Part B, there is some coverage for certain therapies administered using durable medical equipment (a mechanical or electronic external infusion pump). Unfortunately, only a select few therapies are covered and only under very specific conditions. As a result, many Medicare beneficiaries are effectively denied access to home infusion therapy and are being forced into receiving infusion therapy in hospitals and skilled nursing facilities at a significantly higher cost to Medicare and at great inconvenience to the patients. NHIA is underway with a critical legislation initiative to rectify this situation. H.R. 605 and S. 275 Amends title XVIII (Medicare) of the Social Security Act to authorize Medicare coverage of home infusion therapy and home infusion drugs.
How is policy made??? Starts with you at conferences like MAMES! Conversations with DME providers and State Associations. Find a champion to author a bill
I m just a bill... Legislative Process -Must get approval from committees of jurisdiction Senate Finance, Senate Appropriations, Senate H.E.L.P. (Health, Education, Labor Pensions) House Energy and Commerce, House Ways and Means, and House Appropriations. -Must pass House, Senate, President Senate Hotline process Regular Order-House
How do bill get passed? Your Actions! In-State meetings- Hit the Campaign Trail Action Center-What can you do? Contact their Federal Office-Tell your Story Reach out to your local media
Engaging Clinicians, Referral Sources, & Discharge Planners: Participating in Case Manager Survey Educating Referral Sources about Changes Directing to People for Quality Care for more Info
We need support from hospitals! This letter was sent to hospital- based DMEs, asking them to forward to their hospital CEOs. We are asking them to send this letter to Congress explaining the relationship between DME providers and hospitals have on patient discharge. It discusses the threat of reimbursement cuts to DME suppliers and the effect this has on the quality of life in the patient s home and reducing re-admissions. Cleveland Clinic (OH) Unity Point (IA) Wellspan (PA) Buchanan Cty Medical Center (IA) Point Pleasant Medical Center (WV) Franciscan (NY) Mayo Clinic (MN) Sanford (ND, SD, MN)
Engaging Customers & Family Caregivers: Educating Customers About Changes Directing Customers to People for Quality Care -Complaint Hotline 800-404-8702 -Letters to Congress to Voice Concerns
We need the beneficiary voice now! Give this letter to your patients. Direct them to reach out to their member of Congress Call People for Quality Care 800-404-8702
Engaging Other Stakeholders: Local/State Senior Service Groups Patient Advocacy Groups NFIB and SBA
Industry Focus Competitive Bidding Post Election Focus Intermediate Competitive Bidding Long Term Competitive Bidding-Nationwide Rollout in 2016 State Licensure Vent Legislation Infusion Legislation Grassroots Efforts Beneficiary Awareness and Mobilization
Thank you MAMES!! VGM and AAHomecare working for you. Jay Witter AAHomecare jayw@aahomecare.org John Gallagher VGM Group, Inc. john.gallagher@vgm.com