Will Price pull-through?

 - 
03/29/2017

HME stakeholders have always had a dual strategy: regulatory and legislative.

But with industry champion Tom Price as the new secretary of Health and Human Services, their regulatory strategy has taken on a new sense of urgency.

Stakeholders haven’t wasted time calling on Price, who came onboard in February, to take swift action on a number of issues, most of them competitive bidding-related. In March, both AAHomecare and The VGM Group wrote him letters, detailing their wish lists.

Also in March, I saw this info in the most recent bulletin from the Midwest Association for Medical Equipment Services: “On the advice of congressional committees of jurisdiction (House Ways and Means, Energy and Commerce, Finance), AAH is working regulatory routes to determine if there needs to be a legislative route.”

Again, stakeholders have always had a dual strategy, but it appears they—and their champions in Congress—feel that’s more than going through the motions, now that Price is CMS’s boss.

It’s still early, but there does seem to be a new air of cooperation at CMS. I listened to two Special Open Door Forums on the agency’s new prior authorization process for two complex rehab codes, and for the most part, all of the questions that providers had were answered. There was less of the standard, “Email us and we’ll get your question to the right person” response that has been typical during past forums. What’s more: Things that providers asked for during the first call (concrete examples of accessories that would be considered part of the process, for example) were delivered during the second call.

Then this morning, I saw a Change Request in which CMS instructs the contractors to accept timely orders and medical documentation whether they come from a beneficiary’s treating physician or a transferring HME provider. That’s a big deal for providers in competitive bidding areas, where transfers of beneficiaries from non-contract to contract providers are common.

While these are positive signs, the big questions remain: Will Price pull-through where it matters most, and lead CMS in overhauling the competitive bidding program?

We’ll soon find out.