Industry reaches ‘inflection point’ in bid areas

• Industry scored major wins in an end-of-year spending bill 
• But, outside of annual updates, reimbursement relief in former competitive bidding areas has been elusive 
• Stakeholders are now working on a strategy for providing relief in those areas, but CMS’s plans for the next round of bidding is an obstacle 

WASHINGTON – Industry stakeholders “left everything on the field” in December, paving the way for Congress to pass several HME-related provisions as part of a large spending bill, but they're now back at it again to provide relief in former competitive bidding areas.  

The good news, stakeholders say: They’re not starting from scratch with H.R. 6641, which was not included in the bill and which would have implemented a 90/10 blended reimbursement rate in those areas. HME champion Rep. Cathy McMorris-Rodgers, R-Wash., for example, is set to lead one of the Hill’s most powerful committees, Energy & Commerce, in the 118th Congress.  

“(H.R. 6641) was the Energy & Commerce’s bill – they wrote it,” said Jay Witter, senior vice president of public policy for AAHomecare. “There was a procedural challenge in getting a score from the Congressional Budget Office, but we don’t believe there was an issue with the policy. Our champions are ready to go. We’re vastly ahead of the game of where we were.” 

The $1.7 trillion spending bill passed by Congress included an extension of the 75/25 blended reimbursement rate for non-CB/non-rural areas through the end of the public health emergency or Dec. 31, 2023, whichever is later; and a delay of a 4% across-the-board Medicare cut for two years. 

Another challenge for H.R. 6641 was uncertainty around CMS’s plans for the next round of competitive bidding, after the last round largely failed due to lack of cost savings.  

“It’s the biggest inflection point,” said Tom Ryan, president and CEO of AAHomecare. “We have to get an idea from CMS on where they are at on competitive bidding, so we can take a longer-term approach here.” 

At the current rate, the best guess on when a new round could be in place is 2025, stakeholders say, with CMS’s hands full planning for the eventual end of the PHE. H.R. 6641 would have implemented a 90/10 blended reimbursement rate through Dec. 31, 2023. 

“We haven’t gotten the sense that the bid program is a front-burner issue,” said Cara Bachenheimer, who leads the Government Affairs Practice of Brown & Fortunato. “That could change at any point, but the regulatory process is drawn out and they’d need, essentially, at least a year if not more to implement anything.” 

In addition to reconsidering the timeframe for relief, stakeholders might also have to reconsider the 90/10 blended rate, itself, to make it more fiscally palatable. 

“It’s a conversation we need to have across the industry, but Congress has already indicated it has the stomach for a 75/25 blended rate, why not have that across the board in non-CB and former CB areas,” said John Gallagher, vice president of government relations for the VGM Group. 

Stakeholders have a lot of work to do yet, in other words, but they’re going into 2023 with a lot of momentum. 

“We were successful in December, because we worked hard,” Witter said. “Throughout the process, when there was a vulnerability or obstacle, we worked through it. Sometimes when you have these battles in Congress, you ruffle some feathers and people are not happy. That’s not the case this year. We’ve always had respect, but even more so now.” 

• Read more about what’s in the spending bill. 
• Read about the industry’s flurry of lobbying activity in December.