Executive actions, gag order keep industry waiting

DALLAS – With a new administration in charge and a gag order in place on federal health employees, HME stakeholders said in a session at Medtrade on Wednesday that the industry is trying to keep up with “a whirlwind” of executive orders and disruption across the federal sector. 

“It’s a completely different D.C.,” said Cara Bachenheimer, who leads the Government Affairs Practice of Brown & Fortunato, who co-presented with Kim Brummett, senior vice president of regulatory affairs for AAHomecare. “It’s been a whirlwind of activity. With the gag on everyone, our regular comms folks are not allowed to communicate one way or the other.” 

One thing stakeholders do know: “Medicaid is a hot topic and we’re seeing movement in the House and Senate on a desire to cut funding,” Bachenheimer said. 

In addition to the gag order, President Donald Trump in January also issued a regulatory freeze, pausing any new rules or regulations pending review and postponing effective dates by 60 days for any rules that have not taken effect.  

“We don’t know what’s going on,” Brummett said. “There’s a regulatory freeze so we’re seeing very little from CMS, (including publishing in the Federal Register).” 

Competitive bidding 

It’s been radio silence on the program for a few years. A temporary “gap” in the program began Jan. 1, 2024, and is still in place, says Bachenheimer. 

“It’s unclear whether this administration will reinvigorate the program but if they do, we would see a proposed rule and a final rule, and that’s a process that takes approximately a year,” she said. “If I had to bet, I would say there will be no rule this year.” 

Should the bid program move forward, the earliest Bachenheimer would expect a proposed rule at this point would be Feb. 1, 2026, with an estimated start date for contracting in 2028. 

Intermittent catheters 

The Pricing, Data Analysis and Coding (PDAC) contractor is preparing to roll out new HCPCS codes for hydrophilic intermittent urinary catheters on Jan. 1, 2026, and AAHomecare’s Payer Relations council is putting together provider education on the change, Brummett said. 

“We expect by Oct.1, that PDAC will identify the products under the current codes and the new codes,” she said. “Payment is going to remain the same because regulations in place say if an item was covered under a previously existing code, the same payment applies.”