Stakeholders: 'We're an industry living in crisis'

WASHINGTON - With the fate and details of the interim final rule no longer a mystery, stakeholders and their champions in Congress are putting their full weight behind H.R. 4229, a bill that would provide more broad-based relief in non-competitive bidding areas.

The IFR, published in the Federal Register on May 11, will apply 50/50 blended reimbursement rates, but just in rural and non-contiguous bid areas, and only from June 1, 2018, through Dec. 31, 2018.

“The IFR was holding back H.R. 4229,” said Jay Witter, senior vice president of public policy for AAHomecare. “Now that we know what's in the IFR, it's no longer holding us back.”

H.R. 4229, which has 145 co-sponsors, would apply the blended rates from Jan. 1, 2017, to Jan. 1, 2019. A provision in the 21^st Century Cures Act has already applied the blended rates retroactively from July 1, 2017, to Jan. 1, 2017.

That provision in the Cures Act is proof that Congress is ready and willing to provide more broad-based relief in non-bid areas, stakeholders say.

“They know how to do it,” Witter said. “They've already done it.”

The job of stakeholders now: Educating lawmakers that, while it provides relief, the IFR doesn't go far enough and legislative relief is needed, they say.

“A number of offices forwarded me the IFR when it was released, saying, 'Isn't this the IFR you were looking for!'” said Cara Bachenheimer, senior vice president of government relations for Invacare. “The first impression was, 'This is it; this is great.' So we're going through the painful analysis of spelling out everything for everyone state by state.”

In what's becoming a constant balancing act, stakeholders are also continuing to have conversations with CMS in an attempt to help shape changes to the program for Round 2019, something the agency acknowledges in the IFR must happen. The details of those changes, however, much like the IFR, won't be known until CMS publishes its “CY 2019 Changes to the End-Stage Renal Diseases Prospective Payment System,” likely in late June.

“We're an industry living in crisis and that's a story we continue to bring to them,” said Tom Ryan, president and CEO of AAHomecare. “We need relief and we need a long-term fix. We've heard from CMS that they're working on it.”

Stakeholders will use this week's AAHomecare Washington Legislative Conference to turn disappointment on the IFR into action on H.R. 4229.

“Absolutely, it still has legs,” said John Gallagher, vice president of government relations for the VGM Group.