June 23, 2016

by Inside Health Policy

Senate Passes Bill To Delay DME Cuts; House Vote Pushed Back By Dems' Sit-In


The Senate passed a bill to delay durable medical equipment supplier payment cuts in rural and non-competitive bid areas for a year by unanimous consent Tuesday (June 21) after an attempt to pass the bill through the hotline process stalled, but an expected House vote on a bill to delay those Medicare cuts for three months was put on hold by Democrats' sit-in over gun control. The cuts are set to be implemented July 1, and the chair of the Council for Quality Respiratory Care called for lawmakers to retroactively delay the cuts once they return.


CMS was required to adjust Medicare fee schedule amounts for non-competitive bid areas by Jan. 1. The agency decided to phase in changes to the DME fee schedule rates during the first half of 2016 so that the rates in all areas would be based on a 50/50 blend of current rates and adjusted rates. Another round of cuts is scheduled to go into effect July 1, and stakeholders have been pushing lawmakers to pass legislation to put off the cuts. The suppliers have argued that the impact of the initial cuts isn't yet clear, though CMS has said the lower pay rate has been “more than adequate” and the cuts haven't hurt beneficiaries' health outcomes.


Last week, the Senate started the “hotline” process on the bill, but that process — which requires no objections be raised for 24 hours after a bill is sent to the full Senate for it to pass — stalled. On Tuesday, the bill passed by unanimous consent.


The Senate bill would delay the second payment cut for DME in non-bid areas for 12 months; lock in the bid ceiling for future rounds of bidding at the bid rates in effect on July 1; require CMS to solicit stakeholder input and take into account travel costs, volume, clearing price and information on the number of suppliers in a bid area as part of rate setting in January 2019 and after; and push up the date when Medicaid reimbursement will match Medicare competitive bid rates from January 2019 to October 2018.


Tom Ryan, president and CEO of the American Association for Homecare, said the bill will allow lawmakers to get a better picture of the effects of the first round of cuts before the another round is implemented.


A GOP aide said the House intended to vote on a bill to delay the DME cuts in non-competitive bid areas Wednesday (June 22), but Democrats conducted a sit-in on the House floor before the vote could occur, and as a result of the sit-in the House recessed earlier than expected.


“We are extremely disappointed that the PADME Act was not passed before the July 1 deadline, and strongly urge Congress to act immediately when they return to Washington. Delaying these cuts is crucial to protecting patients and providing the time needed to adequately study how cuts are impacting beneficiary access and care services,” said Dan Starck, chairman of the Council for Quality Respiratory Care. “We ask that leaders in the House and Senate come together to advance legislation that retroactively delays the cuts on July 1 as soon as they reconvene.”


Ryan also expressed disappointment that the House left for recess without voting on its version of the DME bill.


An industry source said the most likely course of action would be lawmakers passing the short-term fix included in the House bill. Another industry lobbyist, however, cautioned that even if the House bill passes, there could be significant challenges in reconciling the House and Senate bills.


Late on Monday, the House added the bill to its list of measures scheduled for consideration this week. That version of the bill pushes back the cuts from July 1 to Oct. 1, rather than a full year as called for an an earlier version of the bill. The version of the bill, the Patient Access to Durable Medical Equipment Act, introduced on May 12 pushed the cuts back to October 2017, and also limited the bid ceiling for future rounds of competitive bidding to the rates in effect on January 2015, along with asking CMS to solicit stakeholder input on travel costs, volume, clearing price and other information to include in rate setting for 2019. The May 12 version of the bill also would have required CMS to publish monthly reports on the results of monitoring beneficiary access to DME and health outcomes.


The revised version of the bill dated June 20 requires CMS to conduct one study on the impact of pay cuts on the number of suppliers providing DME before January 2016 and the number that stopped providing those supplies after the first round of cuts was implemented but before September. The study would also look at the availability of DME between January and September.


The June 20 version of the PADME Act also includes language mirroring the Ensuring Access to Quality Medicaid Providers Act, a bill passed by the House in March that would increase oversight of and state reporting requirements for the termination of Medicaid providers. The PADME Act, like the Ensuring Access to Quality Providers Act, also requires the publication of a fee-for-service provider directory.


The latest version of the PADME Act also includes a section on excluding payments from state eugenics compensation programs when considering an individual's eligibility for a public benefit.


An industry source said the bills indicate both the House and Senate agree that six months was not enough time between the two rounds of DME cuts. However, the offset which passed in the Senate proved problematic in the House, so the House package was changed to essentially kick the can down the road, avoid the time constraints caused by the implementation of the second round of cuts on July 1 and give the two chambers of Congress more time to come together on a larger package that is closer to both the Senate bill and the May version of the House bill. — Michelle M. Stein (mstein@iwpnews.com)



To learn more, visit cqrc.org and follow CQRC on Twitter at @TheCQRC.


Click here to see the original article on the Inside Health Policy website.



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