HME News

OCT 2017

HME News is the monthly business newspaper for home medical equipment providers. This controlled circulation publication reaches 17,100 home medical equipment services providers, including traditional HME dealers & suppliers, hospital- and pharmacy-o

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News 8 www. HM enew S .co M / octo B er 2017 / HM e new S Rates to Provider Relief in Non- Competitive Bidding Areas." It sounds promising, industry stakeholders agree, but because the IFR hasn't been published yet, they have more questions than answers and, therefore, have refrained from spreading the word. "If you just look at the title, it sounds like a good thing, but we just don't know what's in it," said John Gallagher, vice president of government rela- tions for VGM & Associates. "We're waiting on hands and knees." Chief among the questions stakeholders have is what rates CMS is referring to. They were disappointed earlier this year, when CMS implemented a pro- vision in the 21st Century Cures Act requiring the agency to ret- roactively delay a second round of reimbursement cuts in non- bid areas from July 1, 2016, to Jan. 1, 2017, by using the July 1, 2016, rates, instead of the Jan. 1, 2016 rates. "The way I read it, they're either going back to the Jan. 1 non-adjusted rates or they're looking to continue the adjusted rates for a period beyond what was provided in the Cures Act," said Seth Johnson, senior vice president of government affairs for Pride Mobility Products. "So it appears there will be payment relief, but we're not sure what that will look like." An extension of the relief pro- vided by the Cures Act could help providers get through 2017 and 2018, before another provi- sion in the Cures Act requires CMS to modify how it calculates rates in non-bid areas by Jan. 1, 2019. "This could act as a bridge," said Cara Bachenheimer, senior vice president of government relations for Invacare. hme NEW r U l E c o N T i N u e D f r o M pa g e 4 By Theresa Flaher T y, Managing e ditor T HE A MERICAN Hospital Association's lawsuit against the Department of Health and Human Services over a mas- sive appeals backlog has been ping- ponging between the U.S. District Case analysis by Jeff Baird Court for the District of Columbia and the D.C. Circuit Court since it was first filed in 2014. The latest ruling, issued Aug. 11, directed a federal judge to take a closer look at whether it's actually feasible for HHS to clear the back- log by 2021, as previously ordered. "I think the D.C. Circuit Court is saying, while we are not opposed to a court ruling that addresses this appeals backlog, we do think what you did come up with was unwork- able, where HHS just physically can't do it," says attorney Jeff Baird, chairman of the Health Care Group at Brown & Fortunato. Baird spoke with HME News recently to offers his thoughts on the case. hme News: Is it typical for a case like this to drag on? Jeff Baird: No, this is abnormal. In a sense, it is more academic, more of a policy lawsuit. They are going back and forth, basically going through the discussions and deci- sion-making that you would nor- mally think that HHS would go through or Capitol Hill. But Capitol Hill is not addressing this and, up to this point, HHS is not addressing this, so it's a complete mess, so now the courts are saying, we have to address it. hme : Whatever the final verdict, would you con- sider it a short- term or a long- term fix? Baird: Both. Lon- ger-term in the sense that I believe the court ruling will be to clean it up, get rid of the backlog and stay current. But reality may set in where there's not enough ALJs to go around. There needs to be more of a fundamental fix. There needs to be real regulatory fixes that will keep this from snowballing again. hme Jeff Baird medtrade booth 1626 AHA vs. HH s

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