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Update from AAhomecare on Efforts to Alter Medicare CB Impact
Legislative Update: CURES Bill Passes Senate; Signed by President Obama
On December 7, the Senate passed H.R. 34, the 21st Century Cures Act (CURES) by a 94-5 margin, following overwhelming House approval in the previous week.
HME-related provisions in the CURES bill:
- Extends the transition period for the second part of the bidding-derived cuts from June 30, 2016 to December 31, 2016, paving the way for HME suppliers to recoup those reductions for items with dates of service from July 1 to the end of 2016. The second phase of the cuts that had originally gone into effect on July 1, 2016 would again go into effect on January 1, 2017.
- Delays the application of competitive bidding-derived pricing reductions for complex rehab technology (CRT) accessories used with Group 3 power wheelchairs until July 1, 2017, extending the original 12-month delay granted by Congress in December of 2015.
- Accelerates the application of plans to limit state Medicaid reimbursement amounts for HME to the Medicare fee-for-service payment rates, including applicable competitive bidding rates. While this provision currently is scheduled to take effect in January 2019, the new legislation would move implementation up to January 1, 2018.
- Instructs the Dept. of Health & Human Services (HHS) to conduct a study on the impact of the bidding program on the overall number of HME providers and availability of HME products over the course of 2016.
Requires HHS to reissue payment regulations for items and services furnished on or after January 1, 2019, with adjustments to the non-bid fee schedule in some areas based on stakeholder input, costs, volumes and numbers of suppliers serving those areas. This will allow the next Administration an opportunity to provide more permanent relief to rural and non-bid area providers.
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Important- Blue Shield Providers Need to Comment in DME rates effective 12/1/16
We have heard from some of our members re the substantial reductions in Blue Shield of Ca. contract rates for DME. They appear to be a large percentage below Medicare rates. CAMPS has reached out to the Blue Shield Contract staff and emphasized the concern that these new rates are unsustainable and will impair access by their beneficiaries. If you are a Blue Shield contracted provider and concerned with the reimbursement rates effective 12/1/16 you need to contact the contracts unit as soon as possible. We were informed that they have not yet heard from many of their contracted providers.
CAMPS will continue to work with Blue Shield on behalf of our members to educate them on the problems with the Medicare CB rates and other fee schedule changes. We will inform you of our progress as information becomes available.
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One Capitol Mall, Suite 800
Sacramento, CA 95814
t: (916) 443-2115
f: (916) 444-7462
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