Via VGM Group—WASHINGTON, D.C. (December 8, 2016)—On Wednesday, the U.S. Senate has passed the 21st Century Cures Act, meaning that the legislation will be heading to President Obama’s desk to be signed. After overwhelming passage in the House last week, the Senate passed the legislation by an overwhelming majority of 94–5. The president has declared his support for the legislation in his weekly address.
The final legislation included provisions for both DME and CRT that will offer relief to many providers, especially in rural America where reimbursements have been cut by an average of 50 percent in 2016. Below is a brief overview of the key provisions within the bill:
DME rural relief beginning January 1, 2017 (Section 16007-8):
- A six-month delay of the July cuts and reinstates the January 1, 2016, rates. This will extend the period of the January cuts and apply them from June 30 through December 31, 2016. Although it is only a six-month delay, this provides the opportunity for suppliers to recoup the losses from the most recent reduction.
- Requires HHS to reissue payment regulations for services furnished on or after Jan. 1, 2019, including stakeholder input, costs, volume of items and number of suppliers serving the area.
- Requires HHS to conduct a study on the impact that the competitive bidding program has had on the number of HME providers and availability of equipment over the course of 2016. The study is due to Congress by January 12, 2017.
Negative side
- The pay-for in order to make these changes shifts state Medicaid reimbursement amounts to DME Medicaid fee-for-services payments from January 1, 2019, and moves it up to January 1, 2018. However, it would not allow CMS to show the fee screens prior to January 1, 2017, which would mean that state Medicaid’s would not immediately shift to the lower fee schedule.
Complex rehab technology (CRT) competitive bidding delay (Section 16005):
- Extends the application of the competitive bidding program for CRT Group 3 power wheelchair accessories until July 1, 2017.
Infusion drugs (Section 5004):
- Makes changes to the way that infusion drugs are payed and excludes DME infusion drugs from competitive acquisition programs.
Overall, this legislation is a well-deserved win for the DME industry as a whole. VGM’s Vice President of Government Relations, John Gallagher, said, “It is a red letter day for DME providers and their patients with the passage of rural relief. Providers will be able to recoup dollars over the past six months with a foundation being laid for the future with a change in leadership at HHS.”
The coalition of grassroots providers and state associations were the key part in the passage of this legislation, turning around the reputation of the industry on Capitol Hill. The relationships and networks that have been built with providers across the country have directly contributed to this legislation being a key topic of discussion on Capitol Hill.
The effort of independent providers to rally the support of members of Congress, raise awareness of issues by attending Small Business Administration hearings and roundtables, travel to campaign events, participate in state association grassroots efforts and more is remarkable. We ask that providers take the time and thank members of their congressional delegation who supported the Cures bill.
Thank you to each and every provider, state association and advocacy group that has contributed to this effort. VGM and other industry stakeholders remain focused on a long-term solution to ensure providers will have the ability to serve their patients for years to come.
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