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“The key is will there be a piece of moving legislation that can get this accomplished,” he continues. “If you have to go legislative, more often than not, you have to be concerned with what the pay-for will be.”
Protecting CRT Accessories
Another “here and now” issue particularly for mobility providers in non- bid areas, and specifically those offering complex rehab technology,
is the use of competitive bidding rates to adjust the reimbursement for CRT accessories.
Somehow, in a move that left many in the industry with their jaws on the floor, CMS started applying bid rates to those accessories when it planned and implemented the national expansion of competitive bidding. The industry fought the move, but CMS went ahead and did it anyway, which felt to many like the agency was making an end run around existing Federal law.
“Our argument, that many people on the Hill have agreed with, is that CMS’s policy is not consistent with the Medicare Improvements for Patients and Providers Act of 2008,” Bachenheimer says. “The intent of Congress was to exclude those items completely.”
That law, which was mainly a delay of the first implementation of Round One bidding, also permanently exempted Group 3 complex rehab wheel- chairs and accessories from the bidding program. However, when CMS imple- mented the national expansion of competitive bidding, it suddenly started
For now, the CURES Act extended the exemption from bid pricing of CRT accessories that were originally passed through Patient Access and Medicare Protection Act through June of this year, but a more permanent fix needs to happen. The hope is that Congress won’t have to be involved.
“There’s a very strong argument that this can be undone administra- tively — just like it was ‘done up’ administratively,” Bachenheimer notes, explaining that the existing statute — the Patient Protection/Affordable Care Act — that required national expansion, also gave CMS a good deal
of latitude in terms of how it implements that expansion.
“Congress told CMS to use information from the bid areas to adjust
prices in non-bid areas. It doesn’t say, ‘use the bid prices in non-bid areas,’ she explains. “So, CMS has the authority to adjust that underlying regula- tion, which defines the payment amounts and the timing, the phase-in and that sort of thing. So that could be completely changed at the administra- tive or regulatory level without a legislative fix.”
“So we’ll be pursuing that with the new administration,” Bachenheimer continues. “But we will also — and this is probably less immediate — will be pursuing something [legislative] with folks on the Hill,” she adds.
A legislative fix is more of a long-term strategy meant to solidify the exemption in order to protect the benefit throughout future administrations and Congresses, Bachenheimer adds.
“We’re expecting legislation to be reintroduced by the champions that largely carried the water on PAMPA last year: Sens. Casey and Portman, and Rep. Zeldin who is close to securing Democrat co-lead to join him in that effort in the House,” Pride’s Johnson adds. “So we’ll have that legislation to provide permanent protection for complex rehab accessories.”
As we can see, with the parallel efforts to advance legislative fixes to the two hear and now problems of rural relief and protecting CRT accessories, the industry isn’t taking any chance. But there has been an undeniable shift in Washington, and it might take some time to survey the changes. Like people walking out into the sunlight after years of living in darkness, it will take a while for the industry to get a lay of the land.
For many providers, this legislative and regulatory re-set might feel like completely new territory. It’s been a long time since the industry has had a CMS that’s been willing to work with it, or a Congress or Executive that have been willing to work in concert with that agency. But that is the new lay of the land, and it offers that rare commodity that’s been in such short supply for the HME industry: hope. n
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