Final push for rural bid relief

Friday, October 21, 2016

When the HME industry last year began to take in the full potential effects of the looming application of bidding-derived pricing for rural and other non-bid areas, providers and industry stakeholders alike were alarmed at potential cuts of 50% or more for many mainstream HME products and services compared to 2015 fee schedule rates. Given the potential for these new rates to drive suppliers in small communities out of business and irreparably harm an important part of the healthcare infrastructure serving small towns throughout the country, AAHomecare’s leadership decided to make rural bidding relief legislation a top priority in 2016.

While we’ve managed to pass a Senate bill (S. 2736) that would roll back the July 1 portion of the cuts for a year, to give policymakers more time to study the effects of these rate reductions on patient access and health outcomes, similar legislation in the House of Representatives (H.R. 5210) hit determined opposition from members on the Energy and Commerce Committee, who insisted on a much shorter delay period. In the end, long recesses from mid-July through August and again in October through the election season did not allow enough time to get the House and Senate to agree on a single bill.

Preparing for the fight in the lame-duck session

We have one more chance to get legislative action on this issue between the time Congress returns after November’s elections and the time it convenes in January—a period commonly referred to as the “lame-duck” session. Discussions with our champions on Capitol Hill and staffers on important committees during September have demonstrated continued strong interest in getting legislation passed that will roll back the July 1 cuts. In addition, one of the most powerful members in congressional leadership said on more than one occasion in September that getting action on this issue will be a priority during the lame-duck session.

While these developments give us reason for optimism that we’re well positioned to finally get the House and Senate to agree on a single bill, our experiences in the last year (and in finally getting binding bid legislation passed in early 2015) tell us that a successful outcome is far from guaranteed.

To that end, we’re asking all providers and other HME stakeholders to join us in one final push to get rural relief legislation passed in the coming year. The message to Capitol Hill is clear: Please pass legislation to roll back the latest Medicare cuts for rural providers so we can study the effects of these drastic reductions on patient access. You can find a congressional directory with contact info at—and you can also quickly and easily send letters to Congress from that site, as well.

Not just a rural issue

Bidding-derived rates are causing problems for all providers, due to a “domino effect” that stems from the influence of these rates on other payers. These bidding-derived rates aren’t just applied to rural and other non-bid areas—they’re also a basis for rates for Tricare plans and other payers, and will also eventually become the basis for Medicaid rates in 2019. While AAHomecare has made new investments in staff to represent HME industry interests to these payers, rolling back the latest round of cuts for rural providers will likely be the most direct route to sustainable rates in these significant lines of business for all HME suppliers.

We’re stronger together

I want to thank the hundreds of companies, large and small, that have made an investment in AAHomecare through their membership and service on our various councils and workgroups; you have furnished energy, guidance, and resources needed to help us get close to this much needed win that will help all providers.  

For the companies that aren’t yet part of our association, I’d like to invite you aboard so we can bring more resources and enlist your passion and experience as we work to bring about a less burdensome audit process, fight for fairer reimbursement rates for all providers, and simplify the stream of requirements and procedures that stands between suppliers and patients. hme 

Tom Ryan is president and CEO of AAHomecare.