- The American Association for Homecare is ramping up efforts to influence lawmakers and CMS ahead of the agency's proposed rule outlining 2020 changes to CMS' Durable Medical Equipment, Prosthetics, Orthotics, and Supplies competitive bidding program set for release in June.
- At issue is how Medicare and its DME competitive bidding program treat a variety of products including complex rehabilitative wheelchairs, home oxygen equipment and non-invasive ventilators.
- The trade organization, which spent $200,000 on lobbying during the first quarter, is backing three bills recently introduced in Congress: one to establish a separate Medicare benefit category for CRT; a second to exclude manual CRT accessories from the Medicare CBP; and a third to eliminate the oxygen budget neutrality requirement and make permanent additional payments in rural areas.
Two bipartisan House lawmakers and Sen. Bill Cassidy, R-La., are lending support to AAHomecare in its effort to prevent CMS from adding non-invasive ventilators to the DMEPOS CBP in 2021.
In two letters being circulated for signatures in each respective chamber before being sent to HHS Secretary Alex Azar and CMS Administrator Seema Verma, Reps. Morgan Griffith, R-Va., and Peter Welch, D-Vt., and the senior Republican senator from Louisiana express concern that patient access to non-invasive ventilators will suffer.
"Given the unique bundled payment for ventilators, combined with the extensive specialized services that accompany them, we believe there are inherent risks and potential unintended consequences in moving these services to the competitive bidding program," the Cassidy letter, which a spokesperson told MedTech Dive is not yet final, states.
AAHomecare spokesperson Gordon Barnes told MedTech Dive the trade lobby is not pressing Congress to introduce legislation banning CMS from adding non-invasive ventilators to its CBP, and a Cassidy spokesperson said Cassidy's office does not plan to do so.
"We had a lot of success with congressional interest in helping us get some relief in the ESRD DMEPOS final rule last year," Barnes said. "We think it's an important avenue to have Capitol Hill involved to weigh in on CMS on these issues."
Two major companies that sell non-invasive ventilators include ResMed and Philips' subsidiary Respironics. In an June 2018 SEC filing, ResMed said it is in the process of expanding product offerings in the non-invasive ventilator device space.
"ResMed shares the concerns of clinicians and patient advocates who object to CMS' plans to include noninvasive ventilators in competitive bidding," ResMed's senior director of government affairs Larissa D'Andrea told MedTech Dive in a statement. "We support their efforts to urge CMS to revisit the policy."
Despite the slate of bills recently introduced in Congress, Cowen Washington Research Group's Eric Assaraf told MedTech Dive efforts to pass DME-related legislation this year are unlikely to succeed.
"You need a vehicle and that is a stumbling point," Assaraf said. "You probably only have the one must-pass budget bill. That's going to include the debt ceiling raise and fiscal 2020 funding. You can make arguments for and against the kitchen sink, including DME, being added on, but my guess is that it gets left off."
AAHomecare also plans to attend a recently announced June 4 CMS Special Open Door Forum on the addition of five support surface codes, including powered air flotation beds, to Medicare's prior authorization program.
"We're generally supportive of prior authorization, but we want to make sure that the process works and patients can get their equipment in a timely way," Barnes said. "The devil is in the details on how the prior authorization process works. It eems to be working well so far for power mobility products and we look forward to seeing how it is going to work for support surfaces."