WASHINGTON--Home oxygen providers braced for another body blow last week when the House of Representatives passed the Children's Health and Medicare Protection Act (H.R. 3162), which includes an 18-month cap for oxygen rental as a means of paying for the $50 billion bill.
In a vote of 225-204, on Wednesday the House approved what is known as the CHAMP Act, which provides medical coverage for uninsured children under the State Children's Health Insurance Program and eliminates most of a 10 percent physicians' reimbursement cut set to take effect in 2008. The bill, which also eliminates the first-month purchase option for power wheelchairs, would be funded through a tax increase for cigarettes and a series of payment cuts to Medicare Advantage plans and health care providers.
The House action preceded by a day the Senate's passage of its version of an SCHIP expansion. That $35 billion package reauthorizes the program--which is set to expire Sept. 30--and would be paid for largely by a cigarette tax increase. The Senate bill does not include the DME cuts.
Representatives from the House and the Senate must hammer out a compromise once Congress returns from its August recess. While President Bush has said he will likely veto the legislation, stakeholders are hopeful the HME industry can put forth enough effort to keep the oxygen and PWC provisions from appearing in the compromise bill before it is sent to his desk.
"We think we have a very good shot at getting oxygen and power wheelchairs out of it," said Cara Bachenheimer, vice president, government relations, for Elyria, Ohio-based Invacare. "And there is a huge question if they can come up with a compromise package the president will sign."
However, Bachenheimer continued, it is "critical" that providers spend August communicating with their legislators about the provisions. "We have a lot of support, but we need people to be educated about these issues," she said.
"I don't think by any stretch of the imagination that the battle is lost here," said Joe Priest, president and COO for AirSep, Buffalo, N.Y. Priest also appealed to providers to contact their federal legislators about the issue. "There is time, but ... you need to voice your concerns through your [representatives] and your senators, and that can make a huge impact."
Although a 13-month oxygen cap surfaced earlier this year in President Bush's 2008 budget proposal, the industry had not expected the oxygen and PWC cuts to be included in the SCHIP legislation. According to Bachenheimer, the provisions weren't in the House bill "until the 11th hour ... but then they said, 'We need some way to pay for this gigantic package, so everyone is going to pay.' Virtually every provider has some cuts in there."
Legislators, bound by law to provide a means to pay for the cost of the expanded children's coverage, focused at first on raising tobacco taxes and initially proposed a 61-cent tax increase on cigarette sales. The Senate version of the bill, in fact, would be funded by that tax. But in the end, House lawmakers declined to raise the tax more than 45 cents a pack--and homed in instead on Medicare reimbursements.
The Congressional Budget Office has estimated that eliminating the PWC first-month purchase option would save $600 million over five years and $900 million over 10 years. Lowering the oxygen rental cap from 36 to 18 months would save $1.8 billion over five years and as much as $6 billion in 10 years.
"If [this oxygen cap] ends up going through," Priest said, "I think the real detriment will be to the patient. This is a huge reduction in reimbursement. For [providers] to continue to provide equipment, they are going to have to drive every nickel of service out of this. You are virtually going to drop off the equipment and go."
That would, Priest predicted, prompt escalating hospital readmissions and trips to the emergency room.
While Bachenheimer said nothing can be certain about the bill's outcome, she noted increasing support for the industry in the halls of Congress and said HME has allies in the Senate who oppose the home care cuts. She pointed to a July 27 letter from Sen. George Voinovich, R-Ohio, to Senate Finance Committee Chairman Max Baucus, D-Mont., in which he wrote of his opposition "to further cuts in the Medicare DME and oxygen benefit."
Bachenheimer also pointed out that new oxygen equipment technology has consistently been exempted from competitive bidding and the 36-month cap as well as the House version of the CHAMP Act. But the industry--everyone in it--needs to step up efforts to educate legislators and CMS about HME, she said.
"People have to take the future of this industry into their own hands," Bachenheimer stated.
"It's practically a textbook example of irony that Congress would cut a break for tobacco while cutting back on home oxygen therapy for the older Americans who depend on it," commented Michael Reinemer, vice president, communications and policy, for the American Association for Homecare.
"Everyone favors health insurance for children. But it's a needless and shameful trade-off to attack oxygen and power wheelchair benefits again to expand health insurance for kids. In the days and weeks ahead," Reinemer continued, "we hope providers will join a state-by-state, district-by-district effort to make sure that these provisions do not make their way into a bill presented to the president."
To view the full text of the House of Representatives' CHAMP
bill, click here.
