HME News

JAN 2018

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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hme news / january 2019 / 9 In year that was and the year ahead, all things point to members of Congress g uest commentary Pro tips: How to work with Medicaid programs B Y Tom R Y an T he T i D e is finally starting to turn for the hme sector. i n 2018, C m S added more than $1.5 billion to the m edi- care benefit and to suppliers' bottom lines, mainly in rural a merica, thanks to the hme -related i FR released in m ay, along with the e SRD/D me P o S final rule unveiled in n ovember. These actions represent the most significant reimbursement relief for hme since the bidding program's inception. While this relief for hme was granted through regulatory action, it may never have seen the light of day without a strong push from Capitol h ill. o ur supporters in Congress weighed in with C m S and h ealth and h uman Services repeatedly over the last two years, with multiple strongly supported sign-on letters in the h ouse of Representatives and Senate asking for higher reimbursements for all non-bid area suppliers, as well as ask- ing C m S to address problems in the bidding program methodology. i n addition to these efforts, many legislators reached out directly to C m S in support of our policy priorities. h ow much of an impression did Capi- tol h ill make on federal regulators? o ffice of m anagement and Budget Director m ick m ulvaney, being questioned about the status of the i FR at a h ouse a ppropriations Com- mittee hearing in a pril 2018, noted that he'd "probably received more calls about this than any other rule." Twenty-one days later, the i FR was finally released. r enewing the fight in the 116th c ongress While that relief for rural suppliers for the next two years will help stabilize access to hme in those areas, the failure to address reimbursement rates for other suppliers in the gap period before the next round of the bidding program takes place is unacceptable. i know many advocates in our industry are again ready to engage Capitol h ill on the chal- lenging business environment we face under razor-thin or even negative margins on most products in the bidding program. While i believe we've made a compelling case d e t a i l i n g t h e impacts on both p ro v i d e r s a n d patients in our advocacy efforts, some parties on Capitol h ill and C m S discount our claims as anecdot- al. To overcome those attitudes, we are look- ing to work more closely with hospital groups and other clinicians who have raised concerns about the bidding program and its impacts on the patient discharge process. Support from these high-credibility healthcare stakeholders will carry significant weight with legislators and regulators. We also plan to work with these influential groups and our champions on Capitol h ill to advocate for real-time monitoring practices by C m S that capture the true impacts of reim- bursement cuts. i believe that a transparent monitoring program that utilizes both quan- titative healthcare data, as well as qualitative inputs such as feedback from case managers and patients, is essential to getting more sub- stantial relief for hme . Pushing back on new bid categories o ne new issue we may be addressing in the next congressional session is the potential addition of ventilators and back- and knee- brace products to future rounds of the bidding program. C m S is reviewing comments from the hme community and patient groups on that issue, and if the agency continues down that path, we will work with Congress to see that new products aren't added to the bid- ding program at a juncture when C m S is still working on implementing the next round. Ventilators are an especially bad fit for the bidding program, given both the specialized service requirements for products, as well as the potential consequences for the vulnerable patient population that depends on these life support systems. e x P anding our advocacy network We still have a strong starting base to advo- cate for more extensive relief with 123 h ouse members who co-sponsored h .R. 4229 returning to Congress in 2019. i nterestingly, the rate of turnover for h .R. 4229 co-sponsors in the 115th Congress was identical to that for the h ouse as a whole, at 22%. With 100 new members in the h ouse and 10 in the Senate, and the need to continue to ramp up our outreach efforts in areas where it hasn't been traditionally strong, we have an opportunity to build even more awareness and enthusiasm for our policy priorities in 2019 and beyond. This past year, aah omec- are initiated a Congressional a ccountability Program that recruits individuals in the hme industry who commit to regularly contact- ing their legislators on our priority issues. We currently have contacts designated for 70% of the h ouse and 91% of the Senate and plan to continue growing the program to get as close to 100% as possible in 2019. There is one new member of Congress who is already well well-versed in the value of hme and the challenges facing our indus- try: Congressman Dan m euser, a former executive with Pride m obility who claimed Pennsylvania's 9th District by a 20% margin. g iven Dan's background in helping to build Pride m obility into a major hme manufac- turer and employer, as well as a highly suc- cessful record as Pennsylvania's Secretary of Revenue, i am certain he'll be a very effective leader on Capitol h ill for years to come. g et in the game While we've made great strides in changing perceptions of hme and building support for our policy priorities in Congress over the last few years, i believe we're just scratching the surface of what we can accomplish on the advocacy front. i f we are going to succeed in building on our recent policy wins in the 116th Congress, we need to continue to grow the ranks of passionate and persistent hme advocates to directly engage their senators and representatives. i f you are interested in adding your voice to these efforts, please consider joining us at aah omecare's next Washington l egislative Conference, m ay 22-23, 2019. y ou'll join hundreds of your hme peers to learn about our issues and join in meetings that we will schedule for you with Senate and h ouse offic- es. aah omecare is working to deliver bet- ter reimbursement rates and sensible regula- tory policies for our industry at both federal and state levels. We hope that you will join us as we continue to battle—and win—for hme . hme Tom Ryan is president of the American Association for Homecare. Follow him on twitter @TomRyanHME. B Y Lau R a Wi LL ia R d M e D i C ai D D i R e CT o RS have a huge undertaking, ensuring their pro- grams meet budgets, adhere to federal and state guidelines, and provide excellent patient outcomes. o ne of the rewarding aspects of my role at aah omecare is that i have the opportunity to work with hme providers and industry stake- holders to educate them on how our services can help meet their overarching goal of pro- viding excellent care to 73 million m edicaid beneficiaries nationwide. a ccess to care is an ongoing concern for all state m edicaid programs and focusing on how hme providers can continue to provide care in the least costly setting with excellent outcomes is critical. m ore discussion regard- ing outcomes management and the impor- tance of maintaining a strong hme benefit are crucial to the future of both our industry and m edicaid programs. But how do we do this Request 30-minute meetings and get to the point, advises AAHomecare's Laura Williard effectively with m edicaid directors? l et's begin by considering what is involved with running a state m edicaid program. i consider this daily when trying to navigate the m edicaid rules, regulations and rates. Recently, i had the opportunity to hear from m edicaid directors and regulators on the chal- lenges they face at the n ational a ssociation of m edicaid Directors Fall Conference. This conference is structured for m edicaid pro- grams to learn from each other and from C m S on important issues facing their programs. a ttendees include state m edicaid directors and other m edicaid staff that are integral to running these programs. a lso in attendance and exhibiting at this conference are most of the m edicaid managed care organizations, including Centene, a etna and u nited h ealth Care, as well as vendors offering services to ease the burden and workload of the states. Secretary of h ealth and h uman Services a lex a zar spoke at the opening session. h is presentation centered on a major issue m ed- icaid programs are dealing with cur- rently: treatment of mental health in the states. h e noted that one of C m S's goals is to give the states more flexibility on how they treat mental illness, and reiterated inpatient treatment is just one part of what should be a more complete continuum of care in treating these issues. a zar also discussed the recently published m edicaid managed care rule, explaining how it will offer states more flexibility in managing their m C o pro- grams. Comments for this rule are due Jan. 14, 2019. aah omecare will be submitting comments and will share them with the hme community, suggesting messaging and details on changes to assist providers with formu- lating their own comments. The association has been discussing the need for more over- sight of m C o plans with state m edicaid pro- grams and C m S officials. We will continue to make this a focal point of our comments in any m edicaid discussions, comments and meetings. o ne of the more beneficial aspects of the conference was the opportunity it provided to strengthen partnerships with state m edic- aid directors and programs. i t was refreshing to hear directors provide open feedback on when and how to engage them on the chal- lenges we face serving their beneficiaries. o ne recommendation i appreciated is to ask for a 30-minute meeting, which makes it easier to get on their schedule. m edicaid directors believe most issues can be handled in 30 minutes, if you get directly to the point. Slide deck presentations are not necessary, and as one m edicaid director explained: " y ou do not have to take 15 minutes to discuss your l aura w I ll I ard T o M ryan l a u r a w i l l i a r d o n m e d i c a i d s e e pa g e 2 2

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