HME News

APR 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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6 WWW.HMENEWS.COM / APRIL 2018 / HME NEWS Editorial PUBLISHER Rick Rector rrector@hmenews.com EDITOR Liz Beaulieu ebeaulieu@hmenews.com MANAGING EDITOR Theresa Flaherty tfl aherty@hmenews.com CONTRIBUTING EDITOR John Andrews EDITORIAL DIRECTOR Brook Taliaferro EDITORIAL & ADVERTISING OF FICE 106 Lafayette Street PO Box 998 Yarmouth, ME 04096 207-846-0600 (fax) 207-846-0657 ADVERTISING ACCOUNT MANAGER Jo-Ellen Reed jreed@hmenews.com ADVERTISING COORDINATOR Christina Dubois cdubois@hmenews.com PRODUCTION DIRECTOR Lise Dubois ldubois@unitedpublications.com REPRINTS For custom reprints or digital reuse, please contact our reprint partner, The YGS Group, by calling 717-505-9701, ext. 100, or unitedpublications@theygsgroup.com ART CREDITS Steve Meyers: cartoon SUBSCRIPTION INFORMATION www.hmenews.com/subscribe HME News PO Box 1888 Cedar Rapids, IA 52406-1888 800-553-8878 Publishers of specialized busi ness newspapers including HME News and Security Systems News. Producers of the HME News Business Summit and the Home Health Technology Summit. PRESIDENT & CEO J.G. Taliaferro, Jr. VICE PRESIDENT Rick Rector Tenacity pays off in 10 states, and counting Superwoman? It's CMR D URING MY monthly cartoon meet- ings with Theresa, I've suggested a few times now, a cartoon wherein Rep. Cathy McMorris Rodgers, R-Wash., is depicted as Superwoman (the old-school Superwoman, the one with full sleeves and a red cape).The logo across her chest would read CMR, as stakeholders have begun calling her. As anyone who knows Theresa knows, Theresa can be a tough crowd and she's always shot my idea down, probably because she thinks it's too cheesy. But it's not hard to envision CMR as Superwoman. Let's take a look, shall we, at what I'm sure is only a sam- ple of what she has done for HME: ✔ Recently, she spearheaded a congres- sional sign-on letter supported by 56 of her peers asking the Appropriations Committee to include H.R. 4229 into budget legislation. ✔ Speaking of H.R. 4229: That's her bill. ✔ With the industry working on bid relief through not only H.R. 4229 but also an IFR, she stepped in there, too, spearheading anoth- er letter, this one pressuring the OMB to fi nal- ize the rule. ✔ Leaving no stone unturned, she also organized a congressional staff briefi ng for AAHomecare and the American Thoracic Society, so they could share their research on the negative effects of competitive bidding. Outside HME, a visit to CMR's website shows she's also passionate about other healthcare-related issues, particularly relat- ed to veterans. She has introduced bills that would provide veterans access to their medical records at all times and direct Vet- erans Affairs to establish Alzheimer's disease research, education and clinical centers. You probably already know she sits on the influential House Energy and Com- merce Committee and its Health Subcom- mittee, but you may not already know (unless you're Ryan, Gallagher or Bachen- heimer) that she's chairwoman of the House Republican Conference, making her the fourth highest ranking Republican in the House and the highest-ranking woman in Congress. The highest-ranking woman in Congress? That's who I want behind me. I still like the idea of CMR as Superwoman. But I also like cheese. hme BY LAURA WILLIARD I N DECEMBER 2016, Congress passed wide- ranging healthcare legislation popularly known as the Cures bill that expedited the implementation of a requirement that the federal portion of Medicaid reimbursement to states for HME cannot exceed what Medi- care would have allowed for these items, in aggregate, beginning on Jan. 1, 2018. CMS provided its fi rst update to Medicaid directors via a webinar in December, but it failed to include information need- ed for states to under- stand how to implement the new requirements. They released additional information less than a week before the Jan. 1 implementation date that confirmed that these requirements do not apply to medical supplies or O&P products and noted that states do have fl ex- ibility in setting rates to ensure access for their patients. The guidance gave states an option of basing Medicaid rates on Medi- care's lowest fee schedule or competitive bid rates for the state (which they described as the "simplest" option), or to conduct a com- parison using both rate and unit utilization data to calculate the aggregate reimburse- ment under Medicare for those same items to show that the state payments are less than the federal allowable. Many in the DME community (myself included) were taken aback by CMS's original deadline of Dec. 31 for states to determine their approach, especially given that their guidance was issued on Dec. 27. AAHomecare quickly pushed back on that un-meetable deadline and helped convince CMS to issue an update giving states the time they needed to assess their options. We also encouraged CMS to promptly publish a list- ing of the codes affected, which has still not occurred. However, AAHomecare received a copy of the list of codes from CMS and provided that to Medicaid directors and the state and regional DME associations for dis- tribution. CMS is still providing this to states as they request it. Since that time, AAHomecare has been working with leaders at state and regional associations to help convince state Medic- aid offi cials to analyze their spending for the appropriate coding and, if under the aggregate, to not perform any rate reduc- tions. If states are over the aggregate amount, AAHomecare is encouraging them to make sure that cuts are limited to the 244 codes affected. As of this writing (March 8), we've received confirmation that 10 states are not changing their rates: Florida, Georgia, Hawaii, Michigan, Minnesota, North Car- olina, Pennsylvania, South Carolina, Ten- nessee, and Texas. Nine states have made the decision to move to Medicare rates but AAHomecare and state associations are hopeful to change the outcome on these, as we are still working with fi ve of those states. We're currently working closely with stakeholders in Ohio, Missouri, North Dako- ta, Colorado, and South Carolina to encour- age those still-undecided states to adopt the aggregate pricing approach. In these states, we want to make sure that state offi cials have a clear understanding of their options. We've also shared our recent studies that show that DME suppliers are already operating at razor-thin or even negative margins on many products and illustrating the threat to patient access. Challenges remain in many other states that are still analyzing their data using tools and guidance provided by CMS. Connecti- cut Medicaid officials, for example, just announced their intention to adopt Medicare pricing across all DME, O&P and supplies codes, going beyond the scope of the new provisions. The state's intention to imple- ment drastic cuts of 50% to 60% with just 30 days notice and without any consultation of the DME community is even more trou- bling. AAHomecare has joined the Home Medical Equipment and Services Associa- tion of New England and NCART in asking for a 90-day delay to make sure Connecticut offi cials have all the information available to make a better-informed decision. Other states have also used this legislation as a plat- form to evaluate and reduce their entire fee schedules despite efforts by stakeholders to convince them of the access to care issues. Our state association partners have done terrifi c work in making sure that Medicaid officials understand their options under the new requirements beyond CMS's self- described "simplest" approach, as well as giving them a clear picture of the poten- tial impacts. For me, it's been rewarding to work with dedicated state associations to fi ght back, and AAHomecare will continue to support their efforts to secure smarter and sustainable Medicaid reimbursement poli- cies wherever we can. hme Laura Williard is vice president of payer relations for AAHomecare. Reach her at lauraw@aahomec- are.org. Laura Williard

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