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AAHomecare Meets with CMS to Discuss Reimbursement Policy & Competitive Bidding


Article from the AAHomecare Insider 8/10/2022:

AAHomecare senior staff met with CMS leaders last week for an update on the Agency’s plans for future bidding rounds and to make the case for HME reimbursement policy priorities.  Jason Bennett, acting director of CMS’ Technology, Coding, and Pricing Group, led the CMS delegation on the productive Zoom session. 

Our key takeaway from the meeting was the inference that CMS does not plan substantial rulemaking on HME this year that would set a new competitive bidding round in motion.  While the prospect of continuing open access to HME products in former CBAs should cheer suppliers, patients, and clinicians alike, reimbursement rates based on bids from seven years ago continue to hamper our industry.

AAHomecare stressed the need for a meaningful adjustment for reimbursement rates that reflect the market realities that suppliers are facing in the wake of both broad-based inflation as well as increased product and operational costs specific to healthcare providers and HME in particular. To illuminate that case, AAHomecare shared a timeline on former CBA reimbursement history and changing costs since the last completed and implemented bidding round in 2015.  AAHomecare also advocated for extending the 75/25 blend for non-rural, non-CBA suppliers beyond the end of the PHE.  

In addition, we asked CMS to help ensure that audits on claims filed during the PHE do not trigger improper denials based on the wide range of waivers in place during that period.  We also specifically requested CMS allow for patients that received a continuous glucose monitor during the PHE to continue to receive related supplies post-PHE, as many of the individuals who qualified under the waivers during the pandemic will not qualify when the PHE finally ends.

Our CMS counterparts appear to understand and appreciate the challenges that the HME community is facing.  Even so, we must continue to engage Capitol Hill on our Medicare reimbursement priorities in the hopes of securing substantial relief at the legislative level, or to generate Congressional pressure on CMS on these issues.  Strong participation in next month’s Virtual Washington Legislative Conference will increase our chances of success on these fronts.

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