Capitol Hill Outreach Needed to Prevent PAYGO Medicare Cuts
Contact your Senators and Representative to help prevent broadly applied Medicare cuts for 2022. Action is needed this week as Capitol Hill accelerates work on year-end legislative packages.
The potential cuts stem from the application of Pay-As-You-Go (PAYGO) legislation enacted in 2010. If not addressed, PAYGO provisions would trigger automatic cuts across a range of Federal programs to cover recent deficit spending increases – in this case, red ink incurred via the $1.9 trillion American Rescue Plan relief package. Under the current scenario, the broadly applied Medicare reimbursement cut for healthcare providers would be 4%, starting in FY 2022. AAHomecare has been a part of coalition efforts that have been working to address this issue since early 2021.
Legislators who are concerned about the potential impacts of such extreme cuts during a public health crisis are now pushing to include language waiving the PAYGO requirements in continuing resolution legislative packages that could move as early as this week.
Please help push these efforts across the finish line! Contact your legislators to ask that they make sure that provisions to waive punishing 4% PAYGO Medicare cuts for 2022 are included in year-end omnibus or continuing resolution legislation. Remind your Senators and Representatives that it was surely not Congress’ intent to finance COVID-19 relief measures through deep Medicare cuts for healthcare providers who are currently going all-out to protect patients and prevent a resurgence of the virus nationwide.
Please also ask your legislators to support extending the current pause to 2% Medicare sequester cuts that was originally granted in April 2020 and are currently set to expire at the end of this year. The moratorium on these cuts should remain effect until the end of the PHE to help offset the higher product and operational costs that healthcare providers are experiencing during the ongoing pandemic.
Please reach out to healthcare staffers for your Senators and Representative by phone or email to ask for their support on preventing the 4% Medicare PAYGO cuts. You can also send a pre-written message on the issue via our Action Center.
Contact Gordon Barnes at gordonb@aahomecare.org if you need contact information for healthcare staffers for your legislators or other assistance in developing or delivering your message.
New Address, Same Neighborhood for AAHomecare
As of tomorrow, AAHomecare will be operating out of a new address – but will remain in the Crystal City neighborhood well-known for its proximity to Reagan National Airport, the Pentagon, and Amazon’s second major headquarters location. Our new building is just over 500 steps to the north of our current offices. The new address is:
1400 Crystal Drive, Suite 460
Arlington, VA 22202
Please update your records with our new address. The main phone number will remain 202-372-0107, and all AAH staff phone numbers will stay the same. However, phone service may be interrupted for a period on our first day in the office, Thursday, Dec. 2.
The Association is taking advantage of current market conditions and our expiring lease to secure new space in a freshly updated building and save money, while remaining in the same convenient and sought-after neighborhood.
Nationwide Injunction Issued Against CMS Vaccination IFR
Yesterday, a Louisiana federal judge blocked the implementation of CMS’ Interim Final Rule (IFR), “Medicare and Medicaid Programs; Omnibus COVID-19 Health Care Staff Vaccination” which would have required certain health care facilities to have a fully vaccinated staff by January 4, 2022. Although DMEPOS suppliers would not have been directly impacted by the mandate, suppliers that contracted or had arrangements with covered health care facilities would have been required to have vaccinated employees. The nationwide halt on the vaccine mandate comes after a Missouri district judge issued a similar suspension in 10 states on Monday.
As we previously reported, the Occupational Safety and Health Administration’s (OSHA) Emergency Temporary Standard (ETS) that would have required large companies with 100+ employees to implement a vaccine and/or COVID-19 testing requirement starting January 4, 2022, was also paused pending multiple lawsuits. Although CMS and OSHA’s vaccine mandates are currently not in effect at this time, both are expected to go through the formal appeals process to determine the constitutionality of the mandates.
DMEPOS suppliers may still be impacted by other federal or state vaccine mandates. For example, under the Executive Order 14042, suppliers that are subcontracted by federal contractors would likely be directed to have vaccinated employees by January 18, 2022.
AAHomecare will be monitoring the developments of the pending trials.
Oxygen Toolkit a Collaboration Between AAHomecare and CHEST
The American College of Chest Physicians® (CHEST) and AAHomecare are have developed an Oxygen Toolkit supporting individuals who require supplemental oxygen and clinicians who prescribe supplemental oxygen to their patients.
The toolkit features four main components
Complete Oxygen Therapy Guide -- comprehensive information including benefits of oxygen therapy, a look into different systems, and a guide for paying for oxygen therapy.
Getting Started -- Covers what to do before, during, and after delivery of the equipment focusing on the relationship between patient and HME supplier.
Does Your Patient Need Oxygen Therapy?-- Written for clinicians, this document covers determining whether your patient needs oxygen therapy, how to order these systems, and how to educate your patient on their use.
“We’re excited to collaborate with the CHEST Foundation to educate patients with lung disease about oxygen therapy,” said Tom Ryan, AAHomecare President and CEO. “Better-informed patients and caregivers will allow suppliers to more effectively support individuals who depend on home oxygen. These new guides are a terrific resource that will help patients and caregivers understand and confidently utilize these essential devices in their homes and when they travel.”
Use these guides to help educate your patients and referral sources about oxygen therapy and products. You can print the guides out or also share by email or on your website. The guides can also be found on AAHomecare’s Tools and Resources page as well as on CHEST’s Oxygen Therapy page. See related press release for further details.
AAHomecare’s New Breast Pump Coalition Actively Seeking Change State by State
In May, AAHomecare invited Breast Pump manufacturers and providers to join a Coalition and work together on issues surrounding sales tax, expanding coverage of a newly added K1005 reimbursement code for breastmilk storage bags, issues with TRICARE and commercial payers, and opportunities to clearly define policies surrounding breast pumps. The Coalition, originally open to all companies in the breast pump space, recently closed to include only AAHomecare members but carries on with the issues defined by businesses across the nation working to secure access to quality breast pumps for mothers.
In September, the Coalition submitted comments to WPSI, the Women’s Preventive Service Initiative which is a federally supported program to review and recommend updates to the current Women’s Preventive Services Guidelines. Comments focus on clinical recommendations to clarify lactation support services and equipment should be provided for each birth as well as implementation of incorporating other accessories into coverage for breast feeding mothers, including nursing bras and pads, cleaning products, and pain relievers.
In November, a subcommittee of the Coalition worked with the Ohio Association of Medical Equipment Services (OAMES) to comment on the Ohio Department of Medicaid (ODM) rules regarding lactation consultants and breast pump coverage. Laura Williard testified on behalf of the Coalition at the hearing along with Kam Yuricich for OAMES. ODM responded to AAHomecare and OAMES within two weeks of the hearing incorporating several of the recommendations into their rule going forward, including:
The addition of new provider types and other qualified practitioners who hold an IBCLC is slated for future phases following the completion of their new systems implementation. Our suggestion to add DME suppliers as a pay-to provider will be added to the list for consideration.
Current coverage only allows for a breast pump once every five years; however, ODM increased availability of a single-user electric breast pump to once every 2 years.
A subgroup of the Breast Pump Coalition has engaged lobbying firms in Washington state and Illinois which have hit the ground running quickly to prepare for the short 2022 legislative sessions. In Illinois, Representative Barbara Hernandez (D) introduced a HB4234 to amend the Use Tax Act to eliminate taxes on breast pumps, breast pump collection and storage supplies, and breast pump kits. You can follow this bill here.
The Coalition will be working on a White Paper and several other initiatives in the coming months. If your company provides breast pumps, we welcome you to join the Coalition. Please reach out to Tilly Gambill, tillyg@aahomecare.org, for more information.
AAHomecare Reaches 56 Million with Positive Media Messages
In just seven months, AAHomecare has reached more than 56 million Americans with a positive message about homecare. With the help of our public relations firm, Keybridge Communications, 32 interviews have taken place and 52 unique media placements secured.
The message is simple: Homecare serves a valuable place in the healthcare continuum. The impact of this message has been great. Through news articles on the importance of implementing a payment fix for homecare, the challenges providers and manufacturers face due to supply chain issues, patient access, and homecare heroes during the hurricane and power outages, AAHomecare has been able to demonstrate the services and challenges involved with providing durable medical equipment in the current reimbursement environment. In turn, these stories are shared with legislators and payers to help explain the need for change and drive legislative and regulatory movement on the DME Final Rule and other initiatives.
Thank you to members of the HME community who have stepped up to speak with media and secured patients who are willing to tell their story. These are just a few samples of recently placed stories focusing on supply chain issues that are impacting HME providers and patients:
On November 23, Steve Yaeger, COO of CalOx, was interviewed by Spectrum News 1 about reimbursement challenges. “You can try to be as efficient as you possibly can, but when a container goes from $2,000 to rent to get product over from oversees up to $20,000, that cost is pushed down to us, so our manufacturers are raising our costs,” he said.
In a CalMatters article on Nov. 22, Terri Racciato, president of Special Care, said “There are people who are trying to sterilize (the tubes) themselves and reuse them. They’re risking serious infection because new supplies aren’t available.”
Tom Ryan’s op-ed on Supply Chain Disruptions Are Hitting Home-Based Medical Care was featured in Insidesource.com on October 6 and picked up by at least 21 additional regional publications.
CBS News 19 in Alabama covered this issue in September with Lee Ann Matthews of Complete Care saying the price for medical equipment is inflated, “Prices have gone up, sometimes double… triple. Shipping costs have gone up and now they’ve gone to a surcharge.”
All of these stories are being used to discuss HME’s challenges with outdated pricing structures with Congress.
OAMES and AAHomecare Comment on Sole Source Arrangements
AAHomecare joined OAMES in comments on Ohio Medicaid’s First Tier, Down Stream and Related Entity (FDR) Agreement or Sole Source Contract Notification form. In addition to commenting and seeking clarifications on the form, the Associations also took advantage of the opportunity to share perspectives on sole source policies that limit or eliminate patient choice, including these points on the impacts for narrowing supplier networks:
"Permitting fragmented and isolated contracts by product or service lines for a benefit that supports patients at home not only disrupts delivery of these items but also severs relationships between providers, prescribers and patients in Ohio’s communities. This model makes no sense as it diminishes rather than strengthens effective care coordination, especially for patients living independently at home, and flies in the face of key lessons learned through the pandemic."
Medical Supplies Council Tackles Issues Impacting Disposable Medical Supplies
AAHomecare’s Medical Supplies Council is one of the Association’s most diverse member groups with a focus on disposable medical supplies including ostomy, urologicals, incontinence, woundcare, and more. The Council met virtually on Monday to share the latest developments in impacting the supplies space, trends with state Medicaid programs and payers, and discuss the status of 2021 goals and potential 2022 priorities.
This year, the Council created several important advocacy resources, including a white paper on the need for providing ostomy supplies specific to patient need to improve health outcomes, educational resources on woundcare Medicare FFS billing requirements, and template letters for payers addressing the supply chain strain on gloves. Additional information on these initiatives may be found on AAHomecare’s Tools & Resources page. The Council will soon be releasing a multi-stakeholder white paper on intermittent catheters as well.
For additional information on the Medical Supplies Council or to join this vibrant member-only group, please contact Ashley Plauché, AAHomecare’s Director of Member & Public Relations at ashleyp@aahomecare.org.
AAHomecare’s quarterly supplier number tracking sheet is now available with October 2021 data. AAHomecare monitors the DMEPOS industry by reviewing the list of Medicare registered suppliers. The updated tracking sheet reveals a slight decrease in the number of locations compared to a year ago. We estimate there are currently about 9,117 traditional Medicare DMEPOS locations across the country. Our updated analysis continues to show about a 29% decrease in traditional DME supplier locations since 2013. To see more state-specific numbers, you can find AAHomecare’s supplier number tracking sheet and "heat-map" here.
Sales Tax and Products Billed Through Insurance: Avoid the Landmines
Tuesday, December 14, 2:30-3:30 PM ET
Presented by: Jeff Baird, Esq. of Brown & Fortunato and Steve Moore, Esq. of Jackson Walker
In the past, DME suppliers primarily billed traditional Medicare and Medicaid. This is changing. With the expansion of Medicare and Medicaid managed care, suppliers are now increasingly billing commercial insurers.
Unfortunately, a number of suppliers have the mistaken impression that they do not have to remit sales tax. Failure to remit sales tax, even when the supplier is unable to collect the sales tax from the patient or insurer, can have serious consequences for the supplier. Each state has the authority to determine its sales tax requirements. While there are similarities across states, there are also differences. For example, a particular product may be subject to sales tax in State A, but not in State B.
This program will present an overview of state sales tax laws and will then focus on the laws of five of the larger states. The program will discuss the sources that DME suppliers can go to in order to determine if a product is subject to sales tax in a particular state. The program will also discuss the steps that a DME supplier can take if it and a state enforcement agency disagree on whether a product is subject to sales tax.
Jay Witter, senior vice president of public policy, met with Senate Finance Committee regarding the DME Final Rule…Kim Brummett, vice president of regulatory affairs, attended the Region B and Region C Council CGS Meetings, participated in a CMS Listening Sessions Innovation Center Strategy call…Laura Williard, vice president of payer relations, participated in the GAMES Board meeting, testified at the Ohio Department of Medicaid hearing on Breast Pumps, spoke at the Brightree Summit, met with ACMESA and Health Blue, and met with members of the Breast Pump Coalition funders along with Illinois lobbyist and Washington Lobbyist…David Chandler, senior director of payer relations, participated in the TexMEP Board of Directors meeting, Texas Medicaid Rate hearing, NEMEP Payer Relations Committee call, New York Lobbyist Call with NEMEP, Excellus payer call with NEMEP, Great Lakes Board of Directors meeting, Great Lakes Indiana legislative strategy call, ACMESA Virginia legislative strategy meeting, and attended the National Association of Medicaid Directors annual conference virtually…
AAHomecare’s Retail Work Group, Payer Relations Council, NIV Work Group, Medical Supplies Council, State Leaders Council, Corporate Partner Providers Council, and the AAHomecare Executive Committee convened…
location. Our new building is just over 500 steps to the north of our current offices. The new address is:
In the past, DME suppliers primarily billed traditional Medicare and Medicaid. This is changing. With the expansion of Medicare and Medicaid managed care, suppliers are now increasingly billing commercial insurers.
