Stakeholders need to ‘stay motivated’ on reimbursement relief

WASHINGTON – It’s been a long year fighting to get Congress to move bills that would extend the 75/25 blended Medicare reimbursement rates in non-bid, non-rural areas, but the last few months of the year could provide the HME industry’s biggest opportunity yet, stakeholders say. 

H.R. 5555 and S. 1294 would extend for an additional year blended rates that were first put into effect in March 2020 and subsequently extended through 2023 via an omnibus bill that passed through Congress in late December 2022.  

“In the past, we’ve always gotten relief in an end-of-year package,” said Jay Witter, senior vice president of public policy for AAHomecare. 

A short-term appropriations bill that passed through Congress in September, allowing lawmakers to retreat to their home districts ahead of the elections, contained several health care “musts,” but there are still several health care extenders that need to be addressed in an omnibus bill, including for telehealth, Witter says. 

That provides stakeholders with a vehicle and a short window to convince the “grasstops” – the Democrat and Republican party leaders in the U.S. House of Representatives and Senate – to champion the industry’s reimbursement relief.  

“Both bills have passed through committees of jurisdiction, so it’s less about pushing for co-sponsors and more about pushing leadership,” Witter said. “Tom (Ryan, president and CEO of AAHomecare) always talks about this: It could get down to four people and at the end of the negotiation, you need them to know this is important.” 

Because the bills would extend the blended rates through the end of 2024 and much of the year has already gone by, relief would either come retroactively or for one year from enactment, Witter says. 

“Whichever is the best way to go and matches the other provisions (in the larger bill),” Witter said. “We’ve talked to leadership about it.” 

It won’t be an easy job, especially in an election year, which is why AAHomecare is “working all angles” to get reimbursement relief passed, says Ryan, including working with champions on a sign-on letter to CMS and, potentially, engaging an outside firm for a “PR blitz” around the association’s recently released report outlining the impact of the expiration of the blended rates on Jan. 1, 2024. 

“This needs to be the largest grasstops effort the industry has ever seen,” he said. “The toughest part is keeping everyone motivated, but everyone needs to give it their all, because the industry is hurting.”   

VGM & Associates has been up for the task, helping its provider members coordinate and host lawmakers at their locations everywhere from Iowa to South Dakota to Utah to Kentucky, says Mike “Ike” Isaacson, senior vice president of government and regulatory relations. 

“It’s not only telling legislators the story but also getting them to see the operations and the reality from the provider’s perspective, especially in non-rural areas,” he said. “The legislators know the classification (as non-rural) isn’t reflected in the geography. We were in Hartford, Ky., talking to King Drug about the challenges of covering such a broad area, especially with other providers in the area closing up shop. We’ve got so many members who are hurting right now.”