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Rural Relief Competitive Bidding Legislation Introduced in House, Call to Action for Grassroots

House legislation to address CMS’ plans to apply bidding-derived pricing outside of competitive bidding areas (starting January 1, 2016) has been introduced today by Reps. Tom Price (R-Ga.) and Tammy Duckworth (D-Ill.)  The new bill, HR 4185, the Protecting Access through Competitive-pricing Transition (PACT) Act, includes provisions that:

  • Apply a 30% positive adjustment to single payment amounts (SPA) (calculated on a regional basis) for suppliers in non-bid areas.
  • Provide a two year phase-in period for bidding derived pricing for non-bid areas.
  • Set the ceiling for future bidding rounds of the competitive bidding program at the unadjusted fee schedule rates in effect on January 1, 2015, instead of CMS’ proposal to set a bid ceiling at the previous bid amount rates.  This is an important component of the legislation that will benefit all providers subject to competitive bidding rates in future bidding rounds.
  • Instruct CMS to revisit pricing adjustments for non-bid areas that takes into account travel distance, clearing price and other associated costs for furnishing this equipment for prices that will be in effect on January 1, 2019.
  • Implement a Market Pricing Program demonstration project to compare an alternative methodology for achieving sustainable savings while preserving access to medically necessary equipment, supplies, and services to beneficiaries.  The ten site demo will include the same DME items as the Competitive Bidding program, require binding bids, weigh historic capacity of bidders, and determine price based on the clearing price.  A separate auction will occur in two states for diabetes testing supplies.

The new legislation is a companion bill to S 2312, which was introduced in the Senate in November.  Staffers for Rep. Price and Sen. Thune worked closely to get similar provisions in both bills, and will have additional chances to take part in negotiations on final legislative language as these bills are considered as part of omnibus budget reconciliation legislation expected this week.

Additional Resources:

AAHomecare applauds Reps. Price and Duckworth for their leadership in driving this legislation that recognizes the additional challenges and expense associated with serving patients in rural and less-populated geographical areas.

Your Action Needed: We urge HME providers, manufacturers and other stakeholders in our industry to express their support for this legislation to their Representatives in the House as soon as possible.  We have updated our current grassroots email letter to include the new bill, but we also encourage HME leaders to make direct contact with their legislators by phone or personal email in support of HR 4185 and S 2312..  Please ask that your legislators co-sponsor these bills and:

  • House Republicans: Contact Speaker Ryan to support including HR 4185 in omnibus spending package
  • House Democrats: Contact Leader Pelosi to support including HR 4185 in omnibus spending package
  • Senate Republicans: Contact Majority Leader McConnell to include S 2312 in omnibus spending package
  • Senate Democrats: Contact Minority Leader Reid to include S 2312 in omnibus spending package

You can find individual Congressional office phone numbers here, or call the main Capitol switchboard at 202-224-3121.  More grassroots resources and  talking points on this issue are available here.

Additional co-sponsors at introduction included Reps. Marsha Blackburn (R-Tenn.), David Loebsack (D-Iowa), Rep. Tim Ryan, (D-Ohio), Cathy McMorris Rodgers (R-Wash.), Kristi Noem (R-S.D.), Peter King (R-N.Y.), Ryan Zinke (R-Mont.), Phil Roe (R-Tenn.), Tom McClintock (R-Ca.), Rod Blum (R-Iowa), and Scott Tipton (R-Colo.).

AAHomecare will provide additional analysis and further details on the legislation shortly.

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