Effective January 1, 2020, new Medicaid allowable caps will be applied to the Federal portion of reimbursement that mirror the Medicare rates in the Competitive Bidding Areas effective January 1, 2016 Legislation to lessen the impact of CMS’ plans to apply bidding-derived pricing outside of competitive bidding areas (starting January 1, 2016) has been introduced today in the Senate.
The new bill, S. 2312, the DME Access and Stabilization Act, includes provisions that:
- Apply a 30% positive adjustment to rural single payment amounts (SPA) (calculated on a national basis) for suppliers in non-bid, “rural” areas as defined by CMS.
- Apply a 20% positive adjustment to regional single payment amount (RSPA) for suppliers in all other non-bid areas.
- Provide a two year phase-in period for bidding derived pricing for non-bid areas.
- Set the ceiling for future bidding rounds of the competitive bidding program at the unadjusted fee schedule rates in effect on January 1, 2015, instead of CMS’ proposal to set a bid ceiling at the previous bid amount rates.
- Instruct CMS to revisit pricing adjustments for non-bid areas that takes into account travel distance, clearing price and other associated costs furnishing this equipment for prices that will be in effect on January 1, 2019.
- Effective January 1, 2020, new Medicaid allowable caps will be applied to the Federal portion of reimbursement that mirror the Medicare rates. The rates for suppliers in competitive bid areas will match the Competitive Bidding Single Price Amounts (SPA), for rural areas will match the new rural single payment amounts (SPA+30%) calculated on a national basis, and for all other regions will match the new regional single payment amounts (RSPA+20%).
OAMES will continue to work with AAHomecare to provide additional analysis and details on the legislation shortly and a grassroots action plan moving forward. You can see a list of ZIP codes considered “rural” by CMS by downloading this zip file.
OAMES Grassroots Action Plan on Legislative Relief
The OAMES staff and Board will be working closely with AAHomecare, VGM, MED Group and other industry advocates to keep our members engaged and updated in this very short and critical time to advance this legislation. As everyone knows, the bid rate expansion will be implemented on Jan 1, 2016, unless legislation is passed to make changes. We’ll be providing more information soon with communication tools and details to help members with their outreach to legislators but VGM has provided some initial resources to get you started.
We need all OAMES members to contact our Senators to ask for the support in co-sponsoring S. 2312. They both serve on the very important Senate Finance Committee so their support is essential. If you send an email, copy Kam Yuricich at firstname.lastname@example.org so we can track our progress. Below is the staff contact in the Senators’ Washington offices on this issue:
> Senator Sherrod Brown’s office: Nikki Hurt at Nikki_hurt@brown.senate.gov, phone: 202-224-2315
> Senator Rob Portman’s office: Sarah Johnson at email@example.com, phone: 202-224-3353
So what’s next? The House version of the bill sponsored by long-time industry champion Rep. Tom Price is expected to be introduced after Thanksgiving. While we worked to have the bills “dropped” at the same time with identical language to streamline passage, this didn’t happen due to the market pricing program (MPP) language that Rep. Price wanted included in his bill; it’s not included in S.2312.
If you’ll recall, MPP is an alternative to the Medicare bidding plan designed by market auction experts with safeguards and real-time efficiencies. Rep. Price’s bill will include language to create an MPP demonstration and we expect to see it introduced around Dec 1. Both bills will go through the legislative process and we’ll see if the MPP language prevails but the House version with MPP will be a heavier lift, primarily because it’s more language and a broader issue than a payment “fix”.
In any case, where we are today with these bills has required months of intense work and years of advocacy efforts in our districts and certainly in Washington DC. Now is the time for a full-court press to stop the expansion of these controversial bid rates to avoid a devastating effect on our providers’ businesses and their customers. Please begin your contacts with your Senate offices now. We’ll have more communication material and strategy details right after Thanksgiving to begin work on the House bill.
Please feel free to contact Kam Yuricich in the OAMES office at firstname.lastname@example.org if you have any questions or would like help crafting your message. This will be moving very quickly in the next few weeks so watch your email closely for updates.
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