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Advocating on Your Behalf

AAHomecare has been focused on outreach to CMS, state Medicaid authorities/health agencies/governors, major third-party payers/MCOs, and Congress to push for policy changes to help HME operate more effectively and safely under difficult conditions during the pandemic. And we have seen success! In the past two years, AAHomecare has helped secure $2,161,200,000 in relief for HME providers.
 
Our efforts include ongoing discussions with CMS leadership, active engagement with state Medicaid authorities and leaders at major commercial third party payers (including spearheading a broadly supported industry letter that has generated significant policy changes from these payers), developing several policy recommendations for the current emergency that were adopted into the recent IFR and other guidance from CMS, industry education and communication efforts, and working with our champions and committee staff on Capitol Hill to get HME priorities into the final version of COVID-19 stimulus legislation.  More details on the policy gains we’ve helped secure through CMS, Capitol Hill, and state Medicaid authorities follow below:

HME Industry Relief during COVID-19 PHE

Relief for suppliers
  • Pause of the 2021 Competitive Bidding Program.
  • AAHomecare worked with HHS to ensure that HME suppliers were included in the definition of “eligible health care providers” who could receive COVID-19 relief payments granted through the CARES Act.  HME suppliers received $1.4 billion from the Provider Relief Fund payments.
  • Successfully advocated for relief for non-bid area suppliers, securing 75/25 blended rate in non-rural, non-competitive bid areas and continuation of 50/50 blend in rural areas in the CARES Act (H.R. 748) signed into law on March 27, 2020 putting $251 million more back into non-rural, non-bid suppliers’ pockets over one year.
  • Estimated $193.2 million in relief for HME suppliers through the 11-month pause of the 2% Medicare sequestration reductions (May 2020-March 2021).
  • Through legislation and working with the administration, AAHomecare was able to prevent cuts and carve out CRT power accessories from competitive bidding derived prices which saves $500 million over 10 years.
  • Through the Consolidated Appropriations Act of 2021, secured a permanent fix for oxygen budget neutrality requirements provided a savings of $650 million over ten years.
Permanent Relief
  • Expansion of medical professionals who can prescribe DME under Medicaid, during and beyond the public health emergency.
  • Removal of non-invasive ventilators from the next competitive bidding round.
Third-party payer & state advocacy
  • $70 million put back in providers’ pockets in the last 2.5 years, $60 million recurring annually.
  • Prevented over $15 million in CURES paybacks from state Medicaid programs to CMS while creating opportunity to maintain/increase DME rates and build goodwill with the state.
  • Tax exemption legislation was passed in North Carolina, saving providers $2 million.
  • Preventing CURES cuts in the amount of $54 million in four states
  • Secured rate floor protection of $14 million in three states
  • Engaged and helped convince major third-party payers, MCOs, and Medicaid authorities to adopt HME policy recommendations to respond to COVID-19, including relaxing proof of delivery requirements, easing prior authorization policy, and expanding respiratory coverage.
  • Spearheaded industry sign-on letter to commercial payers endorsed by 150 suppliers, manufacturers, and other HME stakeholders. 
  • 34 state Medicaid agencies adopted policy recommendations made by AAHomecare and our state association partners.
  • AAHomecare State Legislation and Regulatory Toolkit finalized and rolled out to all state associations.  
  • CareCentrix payment suspension plan for non-life sustaining equipment policy implementation delayed and modified.
  • AAHomecare created a Public Health Emergency Toolkit full of resources for stakeholders to use when speaking with State Medicaid and commercial payers.
Regulatory Relief from cms & hhs
  • Accrediting Organizations (AOs) suspended normal survey activity during PHE. AOs are only conducting on-site visits if the supplier is willing to participate and the survey process is safe. 
  • Early in the PHE, AAHomecare submitted a letter to CMS leadership with recommendations to help suppliers during this pandemic. Majority of recommendations have since been successfully implemented.
  • Medicare will cover respiratory-related equipment and supplies and will not enforce the clinical requirements outlined in LCDs, NCDs, and articles.
  • Face-to-face (F2F) requirement is waived for all items where F2F is required by NCDs and LCDs (including articles) except for power mobility devices.
  • Proof of Delivery signature requirements are waived.
  • Prior authorization program is put on a voluntary hold for all items included in the program.
  • Suppliers can provide a multi-function ventilator (E0467) as an upgrade to beneficiaries who qualify for a ventilator.
  • CMNs are not required for oxygen claims.
  • Audit activities are were suspended for DME MACs, SMRC, and RAC until August 3. Beginning August 3, CMS will only restarted post-pay reviews.  
  • DME MAC TPE audits that were in progress at the beginning of the PHE were released and paid.
  • Expanded use of telehealth to prescribe and reauthorize DME.
  • Physical therapists, occupational therapists, and other health care professionals are allowed to conduct telehealth services.
  • Supplier standards waived for location access, primary business telephone, and hours of operation.
industry education
  • Hosted and/or participated in industry-wide educational webinars to help educate the HME community on new policies, requirements, and best practices related to the rapidly evolving COVID-19 pandemic.
  • Developed comprehensive COVID-19 online resources collecting policy guidance, requirements, updates related to Medicare, Medicaid, and major third-party payers. 
  • More than three dozen COVID-19 alerts and communications have been sent since the beginning of the PHE, providing resources, breaking news, and information. 

Thank you to our member companies for your continued support and active participation in AAHomecare. Our team is proud to do our part to make it easier for you to serve your patients and communities under these extraordinary conditions.  If you would like to review a complete list of all that has been accomplished, please click here (PDF).