ATLANTA — With Congress adjourned for its summer break, the national battle over health care reform moves to home districts, giving HME providers a few more weeks to work on industry issues before legislators return to Washington Sept. 8.
Among items on the industry’s hit list for lawmakers:
- Putting an end to competitive bidding;
- Keeping elimination of the first-month purchase option for standard power wheelchairs out of the Senate Finance Committee’s health reform proposal. That committee has not yet finalized its bill, but a provision in the House version kills the option for standards PWCs;
- Getting rid of the 36-month oxygen cap; and
- No more cuts to oxygen.
Those last two points have mushroomed into a battle of their own as stakeholders argue over H.R. 3220, a bill offered up by Rep. Mike Ross, D-Ark., that would reform Medicare’s oxygen benefit. Opponents say the measure is too complicated to pass, too burdensome for small providers and perhaps too much to tackle right now; supporters say it’s the only way the industry will ever break the cycle of year-after-year cuts to the oxygen benefit.
Although most agree the 36-month cap must end, views on the matter of oxygen reform sharpened last week in back-and-forth messages from the American Association for Homecare, which backs the Ross bill, and the National Association of Independent Medical Equipment Suppliers, which does not.
Amid calls for industry unity, a planned mid-August meeting could bring together representatives from both sides to try to reach some consensus. But the messages from AAHomecare and NAIMES pointed out their differences.
In an Aug. 4 “editorial comment,” NAIMES President Wayne Stanfield wrote: “I [agree] that the DME industry must ‘unite,’ but it is debatable as to who is keeping the sides apart. According to an informal count of suppliers opposing the Ross bill or advancing it as an amendment, it is clear that those opposing are in the majority. The question then becomes if the majority oppose the bill, when will its supporters accept the fact that they need to reach across the divide to unite. Anyone who cares to go back over the chronology of the past 7 months can clearly see how this chasm developed and why small suppliers are untrusting of the supporters of the HR 3220. At last count the state associations representing 22 states were opposed to the bill in its current form.
“It is also debatable whether the Ross bill is the right path and that the oxygen industry will be in trouble if we don't unite behind it. The real trouble is that the 36-month cap is harming patients and forcing suppliers out of business NOW. We must end the cap but a large majority of suppliers do not see the Ross bill as right plan to do that.”
On Aug. 7, under the signatures of seven providers and four state associations, AAHomecare sent out “An Open Letter to Oxygen Providers” that stated: “Oxygen providers are in a battle for survival. The only course of action that will address both the immediate problems associated with the 36-month cap and ensure longer term stability of the oxygen benefit is through legislation in Congress that will reform the Medicare oxygen program. … While H.R. 3220 will undoubtedly need modification and certainly be revised during House and Senate negotiations, the Ross legislative vehicle is the best opportunity for the oxygen community to get its concerns addressed in this session of Congress. Congressman Ross has committed to getting his bill introduced as an amendment to a health care reform bill, and he will work with us to make changes as health reform moves through the legislative process.
“Those in the oxygen community who have complaints about provisions in the Ross bill can point to no other viable legislative option at this juncture for protecting the oxygen benefit. We think the best course of action is to work within the oxygen community to improve the Ross proposal rather than to kill the entire initiative and hope that something better will surface in the coming months. Without a viable reform proposal in the pipeline, oxygen providers face the more likely prospect of further unmitigated cuts to the benefit when the Senate and House reconvene in September.”
Add Another Cut to the List
In the meantime, stakeholders have another unexpected cut to fend off.
Late on July 30, the House Energy and Commerce Committee approved an amendment to its health reform bill calling for a 0.5 percent cut to the consumer price index-urban (CPI-U) update for DME from 2010 through 2013. In other words, whatever the CPI-U updates are slated to be for home medical equipment in those years, the provision would reduce those updates by one-half of one percent.
According to AAHomecare, the cut was proposed by Reps. Doris Matsui, D-Calif., and Gene Green, D-Texas, to pay for Medicare changes related to adult day health services for seniors and prompt-pay discounts for drugs and biologicals.
While the association said it does not object to the policy aims of the Matsui-Green amendment, it strongly opposes using an HME cut to pay for the amendment. AAHomecare said it will work to get the cut stripped from the larger House Energy and Commerce health reform bill.
Lawmakers on the committee will continue work on their bill over the August recess to deal with more than 50 amendments that still must be considered, including addition of the Ross bill.
