Federal Legislation
Medicare Reimbursement Legislation -- Continue to Push for 75/25 Relief in Government Funding Package
The House of Representatives passed a short-term spending bill on January 18 to keep the government funded until the beginning of March, buying lawmakers more time to finish the formal appropriations process; subsequent agreements have extended these deadlines to March 8 and March 22 for different government sectors. The latest packages of proposed healthcare measures do not include extending the 75/25 blended rate for Medicare reimbursement in non-rural areas.
Our lobbying team remains fully engaged in working with our champions to identify opportunities to advance 75/25 provisions in other legislative vehicles -- and your grassroots advocacy plays a critical role in underpinning these efforts.
Please continue to ask your Senators and Representatives to reach out to leadership in their respective chambers in support of extending the 75/25 Medicare blended rates for DME in non-rural areas through 2024 as soon as possible. Specific asks by chamber & party:
- For Senate Democrats: Please ask your Senator to contact Senate Majority Leader Chuck Schumer’s office and ask that DMEPOS relief in non-rural areas as reflected in S. 1294 be included in the next appropriate healthcare-related legislative package.
- For Senate Republicans: Please ask your Senator to contact Senate Minority Leader Mitch McConnell’s office and ask that DMEPOS relief in non-rural areas as reflected in S. 1294 be included in the next appropriate healthcare-related legislative package.
- For House Democrats: Please ask your Representative to contact House Minority Leader Hakeem Jeffries and ask that DMEPOS relief in non-rural areas as reflected in H.R. 5555 be included in the next appropriate healthcare-related legislative package.
- For House Republicans: Please ask your Representative to contact Speaker of the House Mike Johnson and ask that DMEPOS relief in non-rural areas as reflected in H.R. 5555 be included in the next appropriate healthcare-related legislative package.
You should emphsize that cuts have already taken effect and share how they are impacting your ability to support your patients. For Senate members, you can also note that S. 1294 passed the Senate Finance Committee by a unanimous vote on Nov. 8. For House members, you can share that H.R. 5555 passed the Energy & Commerce Committee by voice vote on Dec. 6.
Other messages/info you can use in your messaging:
- Failing to extend the 75/25 blended rate DME reimbursement relief jeopardizes patient access to care and threatens the financial viability of the DMEPOS Industry in meeting our communities’ needs.
- If you’re among the sizable cohort of suppliers impacted by the Change Healthcare disruption, you can note that the current lowered reimbursement rates and narrow (or negative) margins have made it even harder to withstand shocks like this one.
- Cuts that went into effect on Jan. 1, 2024 average 20.1% across top product categories in non-rural areas, with many categories showing reductions of more than 25%-30%.
- Suppliers of DME products like oxygen, wheelchairs, medical supplies, CPAP devices, and hospital beds are currently saddled with Medicare reimbursement rates that haven’t had a market-based adjustment since 2016 and don’t reflect rising product and operational costs facing healthcare providers nationwide. Without this relief, the disconnect between DME reimbursement rates and market reality will only widen – and ultimately threaten access to care for seniors, people with disabilities, and individuals with chronic respiratory conditions.
- Our legislation continues 75/25 blended Medicare rate relief granted in 2022 Omnibus budget for an additional year and provide more stability for suppliers in non-bid areas as well as bolstering rates from other payers who are influenced by Medicare rates, including TRICARE and Medicaid programs in many states.
You can slso share this analysis of the cuts now in effect for the 25 most-utilized DME HCPCS codes to
underscore the impact.
If you took part in our September or November virtual fly-ins, please follow up with the offices you met with to ask for their support. And even if you haven’t reached out to your
legislators before, you can still weigh in with this request. Contact Gordon Barnes at gordonb@aahomecare.org for contact
information for your legislators’ healthcare staffers or any other help in crafting and deliver your message.
You can also send a pre-drafted message to your Senators and Representatives using our Voter Voice
advocacy tool. You can edit the draft letter to include more details about your company and patients, as well as how the disconnect between current reimbursement rates and rising
product and operational costs are affecting your business and your patients. Take action here.
Learn More/Take Action
Issue Brief – Congress Needs to Support HR 5555 to Provide Critical Relief for DME in CBAs and
Non-Bid Areas
H.R 5555 bill Text and co-sponsors
Issue Brief – Support S. 1294: Legislation to Continue Relief for Durable Medical Equipment in Non-Competitive Bidding Areas
S. 1294 bill text and co-sponsors
Legislation Introduced Strengthen Access to Carbon Fiber and Titanium Wheelchairs (H.R. 5371)
Legislation introduced on Sept 8, 2023 in the House of Representatives will increase patient access to a broader selection of wheelchairs. H.R. 5371 allows for code upgrades for titanium and carbon fiber wheelchairs under Medicare, In addition to enabling choice of product that’s best suited for a wheelchair user’s medical, functional, and lifestyle needs, the new bill also removes financial barriers that have prevented some Medicare beneficiaries from being able to benefit from titanium/carbon fiber mobility products.
Learn More/Take Action
Issue Brief – Support H.R. 5371: Legislation to Allow Upgrades Within a Code
for Carbon Fiber and Titanium Wheelchairs Empowers Patient Choice and Access
We’re Here to Help!
The AAHomecare team is happy to help you craft your note, find the appropriate contact, respond to any feedback you get from the Hill, or answer any other questions on this issue. Please email Gordon Barnes (gordonb@aahomecare.org) for assistance.