July 05, 2016

Published by Bloomberg BNA

House Passes Bill Delaying Lower Medicare Rates for Medical Equipment

July 5 (BNA) -- Cuts to Medicare payments for durable medical equipment (DME) in certain parts of the country would be delayed for three months under modified legislation (H.R. 5210) passed by the House July 5.

The Patient Access to Durable Medical Equipment Act was passed by voice vote under a suspension of the rules, which allows for expedited debate for noncontroversial legislation. The vote originally was scheduled for June 22, but a sit-in protest by House Democrats over gun control delayed it.

The legislation would postpone for three months a cut to Medicare reimbursement rates that took effect July 1. The DME industry had complained that the cuts were having a negative impact on beneficiaries and suppliers, and that they should be studied for a longer period. The legislation should provide them with some relief.

The Senate passed a similar version of the bill (S. 2736) in June that would delay implementation of the rate cuts until July 1, 2017.

The House bill would postpone the lower rates until Oct. 1 and would require the Centers for Medicare & Medicaid Services (CMS) to study the impact of payment adjustments on DME suppliers that went out of business during the first nine months of 2016 when the lower rates were being transitioned.

Dan Starck, chairman of the Council for Quality Respiratory Care, said in a June 23 statement that his coalition of home oxygen therapy providers and manufacturing companies is “extremely disappointed” that the legislation wasn't passed by July 1. The coalition strongly urged Congress to pass a bill that retroactively delays the cuts.

Reductions in payments for the items will range from 10 percent to 82 percent in 2016 compared with 2015 in the contiguous U.S., according to the CMS. The new fee schedule amounts are based on information from the bidding program that is in place in 99 regions and applied to nonbidding areas.

In January, the CMS began to install the new rates in noncompetitive bidding areas based on payment information from some of the 99 areas in which there is competitive bidding. To ease the transition, the rates are being phased in. In January, reimbursements were based on a blend of 50 percent unadjusted amounts and 50 percent bid-adjusted amounts.

The Medicare agency has stated that applying the lower rates based on bidding in other areas has not harmed beneficiaries. Specifically, the CMS monitored the first four months—from January to April—and saw no change in health outcomes.

To learn more, visit cqrc.org and follow CQRC on Twitter at @TheCQRC.

Text of the bill is at http://docs.house.gov/billsthisweek/20160620/HR5210.pdf.

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