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3/23/2017
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Welcome
Industry FocusWith a NEW TRUMP Administration
Industry Focus• Competitive Bidding
• Short Term Competitive Bidding-Rural / Non CBA Rollout of Competitive Bid Rates Jan 1, 2017-Re-Bill of Rates July – Dec 2016-Restore rural payements for 02 concentrators (CMS double dip)
• Long Term Competitive Bidding-Bid Rate Expansion to Medicaid-Rep. Price’s MPP Pilot Program
• Complex Rehab Technology (CRT) 1 year delay / 1 July 2017
• Audits
• Vent Legislation
• Infusion Legislation
• State Licensure
• Freshmen Members/Key Committees
• Beneficiary Awareness and Mobilization
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ELECTION OF 2016Electoral College Vote
Hillary Clinton ~ 232
Donald Trump ~ 306
ELECTION OF 2016
115th Congress
House of Representatives Freshmen Members of Tennessee
David Kustoff
8th District
House Committee on
Financial Services
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US SENATE 114 / 115th Congress ELECTION 2018
US Senate
President Trump Cabinet
Newly appointed
John Fleming (R-La)
Former Congressman
Physician
HHS Deputy Assistant Secretary
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Dr. Tom Price-HHS Sec Seema Verma Confirmed To Run
Medicare And Medicaid
TRUMPS First Executive Orders
The order does not offer specifics. Rather, the order notes that the
President intends to "seek the prompt repeal" of ACA. Pending the
appeal, the order directs agency heads to "waive, defer, grant exemptions
from, or delay the implementation of any provision or requirement of the
Act that would impose a fiscal burden on any State or a cost, fee, tax,
penalty, or regulatory burden on individuals, families, healthcare
providers, health insurers, patients, recipients of healthcare services,
purchasers of health insurance, or makers of medical devices, products, or
medications."
ACA / Obamacare ~ Repeal & Replace
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Rep. Price-Patient Centric Healthcare
“All Americans Have Right to Health Care”Price, testifying before the Senate Committee on Health, Education, Labor, and
Pensions, was asked by Sen. Bernie Sanders (I., Vt.) whether he believed health
care was a right of all Americans, rich or poor.
“We are a compassionate society," Price responded. "I believe—and I look
forward to working with you—that we make certain that every single American
has access to the highest quality of care and coverage that is possible.”
"We believe that it's absolutely imperative that individuals that have health
coverage be able to keep health coverage and move hopefully to greater
choices and opportunities for them to gain the kind of coverage that they want
for themselves and for their families."
DME Rural Relief and CRT included in
21st Century CURES Act
• DME Rural Relief
– Retro rates to Jan-July 2016 reimbursement rates
– Provides opportunity for new administration and CMS to make proper reforms
under their own authority
– HHS to conduct a study on the impact that the CB program has had on the
number of HME providers and equipment
• Extension of current CRT delay to keep accessories out of the CB program
for Group 3 power chairs.
• Infusion Drugs- changes to the way infusion drugs are paid and excludes
infusion from Competitive acquisition program.
Letter to Sec. Price
• Implementation of Section 16007 in the
Cures Act to Retroactively Reimburse
Suppliers
• Delaying Reimbursement Cuts Beginning
January 1, 2017
• CMS Applying “Double Dip” on Oxygen
Concentrators
• Reform the Competitive Bidding Program by
Implementing Market Pricing Program
• Addressing the Growing Backlog of Audit
Appeals with CMS
• Complex Rehab Technology Separate Benefit
• TRICARE Reimbursement Reductions
Threaten Veteran’s Access to Care
Long Term: Alternative to Competitive Bidding- MPP
Rep. Tom Price (R-GA)Vice Chair of Budget
Ways and Means
Market Pricing Program
(MPP) Pilot
MPP would replace competitive bidding based problems that economist and auction experts identified in the current program.
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“DME NEW CHAMPION”
Rep. Cathy McMorris Rodgers
Cathy McMorris Rodgers
U.S. Representative
Idaho DME Licensure
With Rep. Jason Monks
Kentucky DME Licensure
Rep. Guthrie and Thad Connally
John with
Rep. Chris Sells of ADMEA
Model Licensure by State
Point of Service• Provide licensure of home medical equipment providers and to provide for the development,
establishment, and enforcement of basic standards that will ensure quality home medical
equipment products and services. The board shall establish, by rules and regulations,
standards by which a home medical equipment provider shall be licensed.
• Must have a principal place of business outside this state shall maintain an office or place of
business within this state unless such location is located in a bordering state and whose
physical location is within _____ miles of state line and meet the requirements of this act.
• Any provider accredited by organizations recognized by the Health Care Financing
Administration and/or The Center for Medicare and Medicaid Services may submit
documents evidencing current accreditation and shall be presumed to comply with the
requirements of the board. Licensing of a Home Medical Equipment Provider that has been
accredited by organizations shall become effective upon written notification from the board’s
staff that the accreditation meets the standards set out in the rules and regulations
promulgated pursuant to this section.
NASHVILLE, TN
CPAP
Total Suppliers 15
Average Distance (miles) 86.51
Less than 50 miles 10
Out of state 0
Manual Wheelchair
Total Suppliers 16
Average Distance (miles) 122
Less than 50 miles 8
Out of state 0
Oxygen
Total Suppliers 14
Average Distance (miles) 76.52
Less than 50 miles 10
Out of state 0
Hospital Beds
Total Suppliers 15
Average Distance (miles) 140.66
Less than 50 miles 7
Out of state 0
ENES
Total Suppliers 13
Average Distance (miles) 89.31
Less than 50 miles 9
Out of state 1
Mail Order Diabetic
Total Suppliers 9
Average Distance (miles) N/A
Less than 50 miles N/A
Out of state 8
NPWTP
Total Suppliers 7
Average Distance (miles) 237.82
Less than 50 miles 1
Out of state 1
Support Surfaces
Total Suppliers 14
Average Distance (miles) 129.59
Less than 50 miles 7
Out of state 0
Walkers
Total Suppliers 18
Average Distance (miles) 169.45
Less than 50 miles 8
Out of state 2
Tennessee’s strong DME licensure serves as a model for other states!
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KNOXVILLE, TNCPAP
Total Suppliers 13
Average Distance (miles) 70.18
Less than 50 miles 8
Out of state 0
Manual Wheelchair
Total Suppliers 13
Average Distance (miles) 73.14
Less than 50 miles 8
Out of state 0
Oxygen
Total Suppliers 12
Average Distance (miles) 74.48
Less than 50 miles 6
Out of state 0
Hospital Beds
Total Suppliers 15
Average Distance (miles) 104.49
Less than 50 miles 7
Out of state 0
ENES
Total Suppliers 9
Average Distance (miles) 94.3
Less than 50 miles 4
Out of state 0
Mail Order Diabetic
Total Suppliers 9
Average Distance (miles) N/A
Less than 50 miles N/A
Out of state 8
NPWTP
Total Suppliers 5
Average Distance (miles) 247.44
Less than 50 miles 0
Out of state 1
Support Surfaces
Total Suppliers 14
Average Distance (miles) 103.73
Less than 50 miles 7
Out of state 0
Walkers
Total Suppliers 14
Average Distance (miles) 115.56
Less than 50 miles 8
Out of state 1
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Success in 2015 & 16! CRT Delayed
Reimbursement Cuts until 1 July 2017
• The last vote in House of the 2015 session was to delay the implementation of CRT
Accessories into competitive bidding. In 36 hours this legislation was introduced and
adopted with zero opposition in the House or Senate through the “hot line” process.
WE
NEED
ACTION
IN
2017!!!
EH1
Audit Reform
• HIP (Hospital Improvement Program)
• Senate Finance Audit Reform (AFIRM Act)
• H.R. 2437- Prior authorization bill by Rep. Marsha Blackburn (R-TN)Seeks to develop and implement improved prior authorization processes for certain durable medical equipment, prosthetics, orthotics, and supplies. Rep. Marsha Blackburn - TN
Face-to-Face DME Rule
• Expect CMS to announce in near future full
implementation
• Manual wheelchairs
• Hospital beds
• Transport and rollabout chairs
• Push rim assist
• Powered seating systems
• Wheelchair accessories (not comprehensive)
• Some oxygen, not Homefill and concentrators
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Slide 26
EH1 Emily Harken, 1/8/2016
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Help us make a strong case for audit reform!The new data submission period for the HME Audit Key is now open for data from the 4th Quarter of 2016. Suppliers can go to HMEAuditKey.org to register;
participation is free – you just need one of your organization's NPIs and respective 5-digit zip code to register and get started.
Your participation in the HME Audit Key Survey will help us continue to build a strong data-set of performance benchmarks while also helping the HME community make the
case on Capitol Hill and at CMS for much-needed audit reform.
This survey provides reliable and representative data that clearly demonstrates the burdensome nature of audits, in terms of volumes, overturn rates, and company
resources required to respond to them.
Currently we are in the data submission period for the 4th Quarter of 2016. If you're having trouble getting started, don't hesitate to reach out for further assistance:
• Support contact form
• Email [email protected]
• Call 1-844-HME A KEY (844-463-2539)
Reminder: Individual Data is NOT Required. For those of you who have not yet delved into the system, please be assured that the Audit Key does not require you to submit
data on individual claims, but instead seeks cumulative counts of pre- and post-payment audits and appeal claim outcomes under DME MAC, RAC and SMRC reviews.
Data Security Assured: Your company's individual information will never be shared, but will be included in the aggregate data. See additional details on how your data is
protected in the Audit Key.
If you haven't yet participated in the Audit Key, please consider joining this data-driven campaign to fix Medicare Audits!
Join the data driven campaign to reform HME audits today!
Ventilator Language Progress
• This bill would prohibit CMS from enacting cuts to the Medicare Part B
Ventilator reimbursement unless it is concluded that the reduction would
not affect access, quality of ventilator in the home, or increase hospital
readmissions.
• Appears as CMS’ latest attempt to transition more product categories
toward competitive bidding reimbursement structures.
Rep. Charles Boustany (R-LA)
Home Infusion Therapy Legislation
Providing home infusion therapy involves not only the
delivery of medication, but also requires professional services,
specialized equipment and supplies to ensure safe and effective
administration of the therapy.
• While most infusion drugs may be covered by the Medicare Part D prescription drug benefit,
the Centers for Medicare & Medicaid Services (CMS) has determined that it does not have
the authority to cover the infusion-related services, equipment and supplies under Part D.
• In Medicare Part B, there is some coverage for certain therapies administered using durable
medical equipment (a mechanical or electronic external infusion pump). Unfortunately, only
a select few therapies are covered and only under very specific conditions.
• As a result, many Medicare beneficiaries are effectively denied access to home infusion
therapy and are being forced into receiving infusion therapy in hospitals and skilled nursing
facilities at a significantly higher cost to Medicare and at great inconvenience to the patients.
• NHIA is underway with a critical legislation initiative to rectify this situation.
H.R. 605 and S. 275 Amends title XVIII (Medicare) of the Social Security Act to authorize
Medicare coverage of home infusion therapy and home infusion drugs.
Grassroots Efforts
• In-State meetings
• Key members of Congress in your states
• Senate Finance
• Action Center-What can you do?
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Spring 2017 Meetings
Rep. Simpson-ID
Sen. Crapo-ID
Sen. Hatch-UT
Rep. Jenkins-KS
Sen. Daines-MT
Sen. Roberts-KS
Sen. Tester-MT
Sen. Thune-SD
Rep. Bucshon- IN
Meeting with Rep. Larry Bucshon (R-IN)
Congressman Larry Bucshon at Williams Brothers Health Care Pharmacy, Inc. in
Washington, Indiana.
This was an important meeting as Congressman Bucshon is a member of the
Energy and Commerce Committee.
At the event, Rep. Bucshon said he fully understands the issues and concerns
with DME providers and their beneficiaries.
Congressman Bucshon, a former heart surgeon, is fast becoming one of the
Republicans’ go-to members when it comes to health policy.
Lead to a meeting with St. Vincent’s Health System in Indiana.
2017 Spring Meetings
Sen. Warner - VA
Rep. Blackburn - TN
Sen. Manchin – WV
Rep. Hudson – NC
National Federation of Independent Business (NFIB)
Don Jones of Southern Medical Equipment in Alabama was elected to the Alabama NFIB
(National Federation of Independent Business) Board. He was able to draw a meeting to the
ADMEA conference with state director of the NFIB, Rosemary Elebash. This meeting was a
great stepping stone to another meeting with the NFIB in Washington D.C.
Networks and relationships continue to be built!
We encourage state leaders and DME suppliers to reach out to your state’s NFIB to
present the case for the HME industry-to keep small business alive!
NFIB
support
letter for
S. 2312
Tennessee State Director – Jim Brown
Phone: 615-874-5288
53 Century Blvd. Ste 250
Nashville, TN 37214
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GO TO:
www.peopleforqualitycare.org/Resources/Personal-Stories
TO VIEW/SHARE STORIES OF BENEFICIARIES IMPACTED BY COMPETITIVE
BIDDING
How can we help you?
Can we help you by educating your patients on why accessing their
equipment is difficult?
People for Quality Care is a
resource for you. Let us know…
Can we help share your story by coordinate a town-hall
event in your community?
Can we connect your patients to non-profits in your area
that can help them with their conditions?
The opportunities are endless! Lets work together!Contact Kelly Turner, 1-866-342-6643
Industry Focus• Competitive Bidding
• Short Term Competitive Bidding-Rural / Non CBA Rollout of Competitive Bid Rates Jan 1, 2017-Re-Bill of Rates July – Dec 2016-Restore rural payements for 02 concentrators (CMS double dip)
• Long Term Competitive Bidding-Bid Rate Expansion to Medicaid-Rep. Price’s MPP Pilot Program
• Complex Rehab Technology (CRT) 1 year delay / 1 July 2017
• Audits
• Vent Legislation
• Infusion Legislation
• State Licensure
• Freshmen Members/Key Committees
• Beneficiary Awareness and Mobilization
VGM and AAHomecare
working for you.
John GallagherVGM Group, Inc.
Thank you ATHOMES!!
Jay WitterAAHomecare
