Industry seeks to fast-track reimbursement relief

WASHINGTON – A new bill in the House of Representatives gives the HME industry a “one-two punch” to get reimbursement relief passed through Congress potentially in March. 

The DMEPOS Relief Act, introduced Feb. 8 by Reps. Markwayne Mullin, R-Okla., and Paul Tonko, D-N.Y., would implement a blended reimbursement rate in competitive bidding areas based 90% on bid pricing and 10% on the 2015 fee schedule, representing about a 10% to 15% increase, to help address rising costs from the COVID-19 pandemic and inflation.  

“It’s a compelling story to tell and we’ve got a great opportunity here,” said Tom Ryan, president and CEO of AAHomecare. 

Meanwhile, efforts are also “well underway” in the Senate to extend a 75/25 blended reimbursement rate for non-bid, non-rural areas that’s in place through the public health emergency as part of the CARES Act, AAHomecare officials say. 

The Department of Health and Human Services in January extended the PHE into April. 

“We’re looking at a one-two punch, with the House working on bid relief, and the Senate on the non-bid area relief,” said Jay Witter, senior vice president of government relations for AAHomecare. “Both issues could boil up and end up in the same package, but it’s not necessary to have a Senate bill. We’re working to get support, so that they accept the House proposal.” 

The 90/10 rate would be in effect from Jan. 1, 2022, through Dec. 31, 2023 – a two-year timeframe that would serve as a transition until CMS announces whether there will be another round of competitive bidding, says Witter. 

“Congress hasn’t gotten a sense from CMS what it plans to do, so the legislation is very targeted for that gap period,” he said. 

AAHomecare has updated a “Campaign Central” page on its website with issue briefs and other related resources, including a pre-drafted letter to send to lawmakers, to ramp up support for the bill, which officials say could move as early as March. 

“There’s a number of items that (Congress) needs to deal with in March,” said Witter. “There should be a number of opportunities, but it’s hard to predict what will be the right vehicle. We’ve done the background work and leadership knows (this needs to happen).”