WASHINGTON (Sept. 3, 2014)—On Sept. 2, the American Association for Homecare (AAHomecare) submitted comments to the Centers for Medicare and Medicaid Services (CMS) in response to the proposed rule CMS-1614-P, “Medicare Program; End-Stage Renal Disease Prospective Payment System, Quality Incentive Program and Durable Medical Equipment, Prosthetics, Orthotics and Supplies (DMEPOS).”
This proposed rule formally announced CMS’s intent to use the single payment amounts (SPAs) from the DMEPOS competitive bidding program to adjust Medicare payment rates in areas outside the competitive bidding areas (CBAs). The rule included a number of other issues pertaining to DMEPOS, including a worrying proposal to amend the competitive bidding regulations to permit the Agency to conduct auctions using bundles of equipment, services and supplies for enteral products and DME.
In response, AAHomecare convened a working group of member company leaders to analyze and reply to these proposals. Download the full set of detailed comments here.
The top line recommendation to CMS reiterated AAHomecare’s position that SPAs are the product of a profoundly flawed competitive bidding program, do not reflect the true cost of doing business and should not be used. AAHomecare recommends that CMS purge bids in a CBA by removing bids from unlicensed suppliers, recalculate the pivotal bids and determine regional pricing by using the revised pivotal bids from CBAs in a state. AAHomecare strongly advises that CMS withdraw the proposed rule until it has balanced bidding data to implement payment adjustment in areas outside the CBAs.
CMS also proposed to amend the competitive bidding regulations to permit the Agency to conduct auctions using bundles of equipment, services and supplies for enteral products and DME. This hybrid payment methodology, combining bundling and competitive bidding, is a radical departure from the current fee schedule methodology.
AAHomecare questions whether CMS has the authority to replace the payment categories under the fee schedules with a new bundled payment. AAHomecare counsels CMS to withdraw the proposal to include bundling under a competitive bidding program.
Even as CMS proposes to discount Congress’ mandate under the fee schedules, CMS lacks any data that can be used to align an individual’s medical necessity for equipment and service to the Medicare payment for those items and services. This type of bundling would be so complex that it is unrealistic for CMS to expect it can implement this new methodology in the near future without placing the welfare of beneficiaries at risk. In addition, CMS has not demonstrated that a competitive bidding program that includes bundling meets the criteria for a demonstration under the Center for Medicare and Medicaid Innovation (CMMI).
“There is a clear lack of quantifiable data behind the reasoning in this proposed rule. CMS does not fully understand the devastating impact of these proposals on suppliers and the patients they serve,” said Tom Ryan, president and CEO of AAHomecare. “This rule should be withdrawn, and CMS can take the opportunity to listen to the people their policies affect and work collaboratively with the consumer groups, economists, Congress and providers who want to help build responsible solutions.”
AAHomecare would like to thank the volunteer leadership from our member companies that were so vital to the process of reviewing the rule, articulating the response and submitting the comments to CMS. Visit aahomecare.org.
