WASHINGTON — Sen. Max Baucus' "Chairman's Mark" version of the Senate Finance Committee's health reform bill mimics current law and potentially subjects all home care companies to Round 1 competitive bidding rates. Rolled out Sept 16, the 220-page proposal is called the "America's Healthy Future Act of 2009."
The line, found at the top of page 195, reads: Starting in 2011, the Secretary has the authority to use information on payments determined in competitive acquisition areas to adjust payments for items and services in non-competitive acquisition areas.
"The way this thing reads, you could say we're all in Round 1," said Rob Brant, general manager of City Medical Services, North Miami Beach, Fla. "If the secretary wanted to, it sounds like she [Kathleen Sebelius, secretary of Health and Human Services] could decide that instead of doing a Round 2, she could just take the competitive bidding rates from Round 1 and implement them in non-competitive acquisition areas."
In such a scenario, rural areas would not have to endure the win/lose bidding process, but they would still have to accept Round 1 rates. And despite CMS assurances to the contrary, Brant and others believe those rates will likely not be viable.
"The main flaw of the program is that Medicare is not going to verify that a company can actually offer products and services at these bid rates," said Brant, founder of the Accredited Medical Equipment Providers Association (AMEPA). "CMS talked about 'bona fide' bids, but all they said is that they are going to check the bids against the manufacturers' wholesale costs; they are still not going to look at the costs of doing business. People are still going to be able to put in bids that they can't afford."
Brant himself was disqualified from the original Round 1 due to a lack of documentation, a situation that likely arose from CMS glitches. This time around, if providers send in bids a month before they are due, CMS officials will notify bidders (if necessary) that they are missing documentation.
Much like last year, the stakes are high for Brant, who relies heavily on Medicare billings. "My business is about 80 percent Medicare," he said. "If I don't win bids, I will be closing my doors."
Baucus, a Democrat from Montana and chairman of the Senate Finance Committee, will meet with committee colleagues this week to begin voting on the plan, with floor debate likely to commence soon after.
The contentious debate is part of an already busy month for health care reform, a month that started in earnest with President Obama's Sept. 9 health care address to a joint session of Congress. As previously noted in HomeCareMag.com, the president mentioned "waste" four times in his comments. "We've estimated that most of this plan can be paid for by finding savings within the existing health care system, a system that is currently full of waste and abuse ...," Obama said during his nationally televised speech. "Reducing the waste and inefficiency in Medicare and Medicaid will pay for most of this plan."
Baucus' proposal would let cooperatives sell insurance in competition with private entities. The provision is viewed as an olive branch to GOP officials who oppose the idea of the federal government selling insurance (the public option). Baucus released the following comments via press release on his Web site:
The plan will make it easier for families and small businesses to buy health care coverage while ensuring Montanans can choose to keep their current health care coverage if they like it, and slowing the growth of health care costs over time. It will block insurance companies from denying coverage because of pre-existing conditions or imposing annual caps or lifetime limits on the amount of coverage they will provide. The bill would also improve the way the health care system delivers care by improving efficiency, quality and coordination.
In addition, the Congressional Budget Office estimates the Baucus plan would make an $856 billion investment in the health care system over ten years. That investment would not add to the federal deficit. Instead, the plan would be fully paid for through increased focus on quality, efficiency, prevention and adjustments in federal health program payments.
View the full text of the America's Healthy Future Act.
See Chairman's Mark Draws Fire for AAHomecare's summary of provisions in the bill that would impact HME.
See Manufacturers Marshal Forces to Battle $40 Billion Tax for discussion of the bill's proposed excise tax on medical device manufacturers.
