CMS rule falls far short of bid relief

‘We have to go back to Congress and tell them, you have to fix it’
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Friday, May 11, 2018

WASHINGTON – The long-anticipated interim final rule landed with a thud last week, when it became apparent that it offered little in the way of bid relief, say industry stakeholders.

“It’s not the IFR we were expecting,” said Cara Bachenheimer, senior vice president of government relations for Invacare. “They didn’t even do half of what were anticipating and, more importantly, what folks on Capitol Hill were anticipating.”

The IFR, published in the May 11 Federal Register, applies the 50/50 blended rates, but only from June 1, 2018, to Dec. 31, 2018, instead of retroactively to Jan. 1, 2017, as the industry had sought.

Furthermore, those seven months of relief will only apply to rural and non-contiguous CBAs. That’s in stark contrast to what lawmakers intended and to a provision in the 21st Century Cures Act that called for a roll back of reimbursement cuts in all non-bid areas.

“The (IFR says it) is a continuation of the Cures Act payment relief, but then it’s limited to Hawaii, Alaska and these super-rural areas,” said Bachenheimer. “It is really very limited.”

That means, even when the IFR goes into effect, a lot of beneficiaries will continue to be vulnerable to access issues, says John Gallagher, vice president of government relations for VGM.

“The majority of the population outside the CBAs are not going to be covered,” he said. “If you’ve got a hospital in Butte, Mont., that wants to discharge a patient to a small town that’s considered not rural, providers are going to say, ‘I don’t go there.’ It’s sheer incompetence by CMS.”

CMS did acknowledge that there are many issues with the bid program—like the oxygen “double-dip”—that need to be fixed, say stakeholders.

“This is the first time, in my experience, that CMS has acknowledged major problems,” said Jay Witter, senior vice president of public policy for AAHomecare. “We’re seeing through the disappointment.”

At press time on Friday, AAHomecare was still analyzing the impact before determining next steps.

“We need for all bid areas to get relief, but we need to get an accurate read of this to give lawmakers further recommendations,” Witter said. “We’ve been communicating with folks on the Hill and will probably go back to them with a request for legislation to fulfill the rest of the relief that’s needed.”

Gallagher already had a meeting planned with Sen. Chuck Grassley’s office on Friday afternoon.

“We want to point out the stupidity of this,” he said. “CMS said yes, there are problems, but they didn’t fix them. We have to go back to Congress and tell them, you have to fix it.”