Stakeholders unpack disappointing final rule

WASHINGTON - The lack of substantial changes in the competitive bidding-related final rule likely comes down to cost, say HME industry stakeholders.

“The challenge has all along been the cost,” said Tom Ryan, president and CEO of AAHomecare. “I think the political appointees at the agency wanted to do more but were restricted by cost. Cost is everything.”

The final rule, released Nov. 1, did not include two areas of additional relief requested by the industry: an extension of the 50/50 blended reimbursement rates to all non-bid areas, and the application of CPI adjustments to rates in bid areas retroactively from 2008-13.

Ryan says it's going to be tough for providers to hold on long enough for CMS to make changes to the program, including implementing maximum winning bids and lead-item pricing, that could help to stabilize reimbursement.

“We've got providers in non-bid, non-rural areas sitting on the financial edge, and it's going to be very difficult without getting some immediate relief for those providers,” he said.

Stakeholders will regroup with lawmakers after Tuesday's elections to see what opportunities and obstacles might arise as the result of changes in Congress. One big question: the fate of H.R. 4229. Spearheaded by Cathy McMorris Rodgers, R-Wash., the bill currently has 156 co-sponsors.

“We need to take a look at it and modify it because of the rule,” said Ryan. “We need to see if we can't move that through committee and get a score. All this needs to be done.”

The lack of additional relief in the final rule raises concerns that access issues will increase after the current contracts expire Dec. 31 and an any-willing-provider provision goes into effect. Providers will no longer be obligated to take patients at such low rates.

“We need to monitor those potential access issues in a much more comprehensive way, since it is unclear how CMS is going to monitor that,” said Cara Bachenheimer, chair of the government affairs practice at Brown & Fortunato. “We are discussing with CMS the need to be much more diligent in figuring out what is going on in those former bid areas.”

At the same time, stakeholders are rolling up their sleeves to make sure the next round of bidding includes their input. They will have their work cut out for them. CMS is already seeking comments on three new product categories to add to the program: off-the-shelf back braces, off-the-shelf knee braces and ventilators.

“We are hoping to work with CMS on a lot of the sub-regulatory decisions, like the details of the product categories,” Bachenheimer said.