December 9, 2015 – The Council for Quality Respiratory Care (CQRC) applauds Reps. Tom Price (R-‐GA) and Tammy Duckworth (D-‐IL) for introducing H.R. 4185, “Protecting Access through Competitive-‐pricing Transition Act of 2015.” This legislation seeks to address the 35-‐50 percent cut to the home respiratory therapy benefit upon which so many of the nation’s elderly rely to remain in their homes and out of more expensive institutional care settings.
More than 1 million Medicare beneficiaries rely upon home respiratory therapies to treat Chronic Obstructive Pulmonary Disease (COPD) and Obstructive Sleep Apnea. Home oxygen and sleep therapies allow patients to remain at home with their families. Home respiratory therapy suppliers provide patient-‐centered services to reduce hospitalizations. Working with hospitals and commercial payors, CQRC companies have developed and implemented programs to help reduce hospitalization and Medicare program expenditures. Managed care programs and commercial payers recognize the important role home respiratory therapy plays in reducing overall health care spending.
However, the decision to dramatically cut rates this January 1 by applying competitive bid rates used in urban areas to rural areas that the Congress expressly excluded from the competitive bidding program makes it less likely that Medicare beneficiaries will fully benefit from home respiratory therapy services in the future.
The CQRC commends these Members of Congress for recognizing the need to account for the cost of providing these essential health care services. H.R. 4185 takes a tempered approach and seeks to provide relief by reducing the size of the cut to suppliers. Instead of the full cut, H.R. 4185 would reduce payments in noncompetitively bid areas – the rural areas of the United States – by setting the rates for three years at the regional competitive bid rate plus 30 percent for non-‐ competitive bid areas. CQRC data support this approach by demonstrating that the full rate cut finalized by CMS would reduce payments to an amount that is significantly below the cost of providing services in these rural areas. If enacted, the legislation would still result in a 15-‐20 percent payment cut for home respiratory therapy suppliers. Thus, the legislation would also provide suppliers in these rural areas with sufficient time to absorb the still substantial cut by allowing for a phase-‐ in of the full cut. It also would establish a demonstration program to test another bidding model to help stabilize the durable medical equipment benefit.
As the Congress and the Administration look toward rewarding high quality care and establishing innovative care models, it is important to protect those beneficiaries who rely on home respiratory therapy and to acknowledge the very real health care services that home respiratory suppliers provide to reduce hospital readmissions and to allow patients to remain at home. The CQRC is pleased that these Members of Congress understand the critical role that home respiratory therapy plays in managing chronic diseases and are seeking to implement practical solutions to improve the benefit.
Who We Are
The CQRC is a coalition of the nation’s eight leading home respiratory therapy providers and equipment manufactures. CQRC members currently provide home respiratory therapy to more than 600,000 program beneficiaries who rely on treatment at home to maintain their independence and enhance their quality of life. Together they employ more than 35,000 people across the United States.
Millions of Americans are living with COPD and Obstructive Sleep Apnea, experiencing acute respiratory failure, or living with neuromuscular diseases. These individuals rely upon home respiratory therapies to remain at home. Learn more about home respiratory therapies and how they can help.
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