Stakeholders 'aghast' at bid proposal

WASHINGTON - Industry stakeholders say they are as surprised as anyone by a proposal to expand Medicare's competitive bidding program to rural areas.

“We don't know who is proposing this or what evidence there is that this idea is prudent,” said Jay Witter, senior vice president of public policy for AAHomecare. “We are going to demand answers.”

The proposal is included in the budget for the Department of Health and Human Services for fiscal year 2019, which was released Feb. 12. The provision would also eliminate the requirement that CMS pay a single payment amount based on the median bid amount, and, instead, pay contract suppliers at their own bid amounts.

HHS says these changes will result in $6.5 billion in savings over 10 years.

“I am aghast that there's belief in the budget that there's $6.5 billion that can be take out of the DME benefit,” said Tom Ryan, president and CEO of AAHomecare. “We've already stripped the benefit and I don't think there's any more savings to be had.”

HHS says in the event that less than two suppliers submit bids in a rural area, CMS will use a reference price from other, similar rural areas. In many of those areas, there could very well be fewer than two suppliers bidding. At a well-attended Capitol Hill briefing Feb. 14, provider Mike Calcaterra, Northern Zone vice president for Norco and the Montana State Chair for Big Sky AMES, detailed how 20% of HME providers in Montana and 37% of providers in Idaho have closed their doors since 2013.

“There's a real access issue,” said Ryan. “We have a solution. We need to get the interim final rule moved forward and we need support for H.R. 4229.”

Other DME-related provisions in the HHS budget include:

Eliminating the face-to-face requirement; testing whether using a benefit manager will result in fewer improper payments and lower utilization; and expanding prior authorizations to orthotics and prosthetics.