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The American Association for Homecare submitted comments today on the ESRD/DMEPOS Proposed Rule that CMS released in mid-July.

“CMS has taken an important step towards improving the bidding program in their proposed rule,” noted Tom Ryan, president and CEO of the American Association for Homecare.  “Adopting a clearing price methodology, coupled with implementing Congressionally mandated provisions to reduce the influence of non-serious or unqualified bidders, should result in reimbursement rates that better reflect the economic realities of our industry.  In addition, extending relief for rural suppliers will have a stabilizing effect on that segment, helping ensure that patients in small communities can maintain access to HME.”

“Our recommendations for further improving the bidding program and reimbursement policy for providers outside of CBAs will strengthen our nation’s healthcare infrastructure and allow our industry to deliver cost-effective and clinically proven care to seniors and other patient groups who utilize HME,” added Ryan.  “I hope our comments will help spur HME companies and other stakeholders to share their input on the Proposed Rule with CMS, as well.  The final version of the ESRD/DMEPOS Rule will have a tremendous impact on our industry for years to come, so it’s critical that we make our best case for improving CMS’ reimbursement policy now.”

AAHomecare's comments focus on five areas:

1) Improvements for the Bidding Program: AAHomecare supports changes to the Competitive Bidding Program (CBP) methodology in the proposed rule, including CMS proposal to change the methodology for calculating single payment amounts (SPA) under the CBP so that the SPA for the lead item in each product category and CBA would be based on the maximum or highest amount bid for the item by suppliers in the winning range.  The Association advocates for additional CBP reforms, including:

  • Working with HME stakeholders to refine product categories used in conjunction with lead item pricing;
  • Dividing the standard mobility product category into separate manual and power categories, and moving walkers to a different category with hospital beds and other products;
  • Excluding mobility repair items and services from CBP and returning allowables for these parts to the 2015 fee schedule;
  • Excluding nebulizers from CBP;
  • Including bids from small providers in calculating SPAs;
  • Ensuring bona fide bids;
  • Clarifying capacity determination methodology;
  • CBP monitoring by auction experts;
  • Increasing CBP transparency; and
  • Removing CMS’ authority to proceed with payment bundling for CPAP and power mobility products.

2) Payment in Former CBAs During Gap Period:  AAHomecare urges the CMS to increase the payment levels in former CBAs beyond CMS’ current proposal. Specifically, the Association asks that CMS establish payment levels at the SPA in the former CBAs, with the addition of CPI updates provided from 2013 through 2018.  AAHomecare’s comments also ask for a CPI update for non-mail-order diabetic supplies.

3) Payment in Rural and Non-Contiguous Areas, Other Non-CBAs: AAHomecare’s comments praise CMS' proposal to extend the 50-50 blended rate in rural and non-contiguous areas during the time period from Jan 1, 2019 through Dec. 31, 2020.  However, the Association strongly recommends that CMS provide the same payment relief in the remaining non-CBAs.  The comments detail the continued threat to the nation’s HME infrastructure in these areas under the current reimbursement model, citing recent studies and input from Congress and other stakeholder groups on the subject.

4) Proposed Oxygen Policy Changes: AAHomecare urges CMS to consider a more comprehensive effort to modernize its Medicare oxygen policies, and to mitigate the effects of the application of outdated budget neutrality provisions to stationary oxygen rates in non-CBA areas.  The Association also advocates for creation of new oxygen payment classes for liquid oxygen, as well as significantly higher reimbursement rates for these products.

5) Gap-Fill Method Replacement:  AAHomecare applauds CMS’ recognition that the current gap-fill methodology is inadequate.  The Association's comments recommend that CMS establish a process, involving stakeholders, to replace the gap filling methodology it utilizes to calculate the payment rate for new and updated HCPCS codes. 

See AAHomecare’s full comments here, as well as recommendations for new product categories noted on page six of the comments.

Comments are due to CMS by COB on Monday, September 10.  Comments can be submitted here.