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Media Campaign Highlights Value of HME and Need for Market-Based Reimbursements

In April 2021, AAHomecare started work on a sustained earned media campaign focusing on the essential, high-value care that HME provides and underscoring the critical need to support our industry.  Over the past nine months, those efforts have led to nearly 100 high visibility media placements in print, online, and on television.  Our partner in this effort, Keybridge Communications, estimates the audience reach for these stories at nearly 130 million people across 26 states and District of Columbia.

The campaign placed an op-ed titled Outdated Medicare Rules Threaten Older Americans’ Access to Home Medical Equipment authored by AAHomecare’s vice chair, Josh Marx, in healthcare-focused STAT News that details the business environment the industry is facing and makes a case for sustainable rates:

Medicare payments are now so out of line with the market that some of the remaining businesses providing older Americans with durable medical equipment will begin to fail, jeopardizing care for many people. To stop that from happening, Medicare must apply meaningful rate adjustments for home medical equipment and related services that reflect the market realities equipment providers face today.

Keybridge pitched and helped develop this widely syndicated story by the influential non-profit outlet CalMatters that details the impacts of product shortages and higher prices and quotes multiple HME suppliers:

“(Shipping) containers have gone from $2,000 for rental to anywhere from $15,000 to $20,000 for the same container,” said Steve Yaeger, a Los Angeles based medical supplier who specializes in respiratory equipment. 

Since the beginning of the pandemic, Yaeger said his overhead has increased 25%. 

“When you see the cost of goods go up like that, all of a sudden you’re figuring out, ‘OK are we even going to make any money this year?’”


Two columns from AAHomecare president and CEO Tom Ryan in InsideSources and the International Business Times discuss supply chain challenges and the cost structure the industry is facing.  These columns were syndicated in dozens of other print and online outlets.
 
Another recent highlight is a Jan. 4 Spectrum News story with video that includes supply and price issues for HME suppliers in the Albany, NY area.
 
“This campaign shows how HME suppliers are supporting patients and caregivers despite unprecedented supply chain issues and reimbursement rates that are disconnected from the cost structure our industry faces,” notes Ryan. “It’s connecting the value of home-based care and the need for market-based reimbursement with the faces of the millions of Americans who depend on HME.  Raising awareness on these issues is critical as we get ready to move forward on Federal legislation to address reimbursement rates, as well as ongoing rate and network access initiatives in several states.”
 
The campaign also led to detailed stories (both subscription-only) that appeared in print editions of the San Francisco Chronicle (For People Relying on Medical Equipment, the Supply Chain Crisis Can Mean Life or Death) and the Montgomery Advertiser (Homecare Medical Companies, Customers Struggle Amid Shortages, Rising COVID Cases) putting the spotlight on supply chain issues that are challenging patients, caregivers, and providers, as well as making the case for market-based Medicare reimbursement policy. 

Ohio Suppliers on Track to Receive ARPA Relief

Efforts to direct American Rescue Plan Act (ARPA) relief to Ohio HME suppliers are close to becoming reality, OAMES reports.  The good news was shared in a stakeholder call with the Governor’s Office and state agencies involved in the effort.

Payments to Home and Community-Based Service (HCBS) providers detailed by Ohio Medicaid include 10% retroactive lump sum payments based on fee-for-service Medicaid billings for:
  • Non-institutional DMEPOS given for claim period 7/01/2020 through 6/30/2021
  • HME and supplies, home modifications and other services are also included in relief under the Ohio Home Care, MyCare, and PASSPORT programs for claim period 11/01/2020 through 10/31/2021
While more steps are needed for the state to complete the process and gain CMS approval, OAMES’ work to convince Medicaid regulators and state legislators to ensure HME providers are recognized as HCBS providers appears to be close to bearing fruit.

“We’re excited to see Ohio HME suppliers are on track for a significant measure of relief on account of the extraordinary care they’ve provided during the COVID-19 pandemic,” said Laura Williard, AAHomecare vice president of payer relations. “OAMES executive director Kam Yuricich and her leadership team deserve a lot of credit for their persistent outreach to policymakers to bring this effort close to the finish line.”
 
“AAHomecare is proud to have developed messaging and strategy to guide these efforts and we continue to work to support leaders in several states to make sure HME is among the entities entitled to ARPA relief,” added Williard. “We need to make sure HME is at the table when this substantial funding is available.”                                                  

New White Paper Highlights Provider, Patient, and Clinician Perspectives on Intermittent Catheter Urological Care 

AAHomecare’s Medical Supplies Council has collaborated with patient and clinican groups to develop a new white paper to educate payers and state Medicaid programs on the types of intermittent catheter products and services needed to successfully manage an individual’s urinary retention needs in a home-based setting to improve patient experience, health outcomes, and reduce overall cost. 
 
The white paper, The Critical Need to Provide Intermittent Catheter Urological Supplies Specific to Patient Need to Improve Health Outcomes addresses the variables going into managing individual urinary retention needs, the role of the HME provider, the risks of improper management, the challenges of limited HCPCS codes for a variety of products, and the value of managing urinary needs with sustainable reimbursement. 
 
“Home medical equipment providers are doing their best to provide the specific catheters that best meet an individual’s unique medical, anatomical, and lifestyle needs within the constraints of the payer’s reimbursement,” explains Laura Williard, AAHomecare vice president of payer relations. “By working with payers to ensure that these benefits adequately cover the cost of providing these products and services, we can remove barriers to care, save the payer money overall via better health outcomes, and increase end user satisfaction.”
 
AAHomecare appreciates the clinical expertise and patient-focused perspectives from our partners in this effort: United Spinal Association, WOCN®, Society of Urologic Nurses and Associates (SUNA), and Wound Ostomy and Continence Nursing Certification Board.  See the related multi-stakeholder press release for additional details.
 
“We are grateful for the expertise and contributions of our Ostomy/Urologicals Work Group that worked diligently to bring this resource to fruition,” notes Ashley Plauché,  AAHomecare’s Director of Member & Public Relations. “This is a great example of how AAHomecare’s councils provide a vehicle for stakeholders to collaborate on collective issues and make an impact.”  For more information on joining AAHomecare’s Medical Supplies Council, contact Ashley at ashleyp@aahomecare.org

COVID-19 Vaccine Mandate Status 

Last Friday, the US Supreme Court held a special hearing on two federal-level COVID-19 vaccine mandates. The Justices heard oral arguments regarding the Occupational Safety and Health Administration Emergency Temporary Standard (OSHA ETS) and Centers for Medicare and Medicaid Services Interim Final Rule (CMS IFR). The Justices will only be making a decision on whether OSHA and/or CMS can continue enforcement of the mandates as the lawsuits move through the court system.  The Court will not be making the final decision on the legality and constitutionality of the mandates, but the Supreme Court’s opinions will likely impact future litigations. This is an unusual Supreme Court hearing and unlike other hearings, the decision on this is expected soon. 

There are three federal vaccine mandates that may directly or indirectly impact DMEPOS companies. Due to the controversy over the mandates, the mandates have been riddled with lawsuits and are in the midst of going through the court system.  Below is a quick overview of the status of each of the mandates as of this publication.  

1.    Occupational Safety and Health Administration Emergency Temporary Standard (OSHA ETS)
Enforcement status: ACTIVE
OSHA ETS requires all employers with 100 or more employees to implement a vaccine policy and have all employees be fully vaccinated or require a weekly negative COVID-19 test. Originally the OSHA ETS required the implementation of the vaccine and testing requirement by January 4, 2022; however, due to court filings, as of December 17, the mandate was reactivated with a delayed implementation date of February 9 with some flexibility as long the employers are making good faith efforts to comply with the mandate. 

2.    Centers for Medicare and Medicaid Services Interim Final Rule (CMS IFR)
Enforcement status: PARTIALLY ACTIVE

CMS IFR requires 21 Medicare and Medicaid certified facility types to have a fully vaccinated staff. This requirement does not directly apply to DMEPOS suppliers, but suppliers that have an arrangement with a covered facility will receive a communication from the facility to have employees working on behalf of the facility to be vaccinated.  Although facilities were required to meet this requirement by January 4, due to multiple lawsuits, the mandate is currently moving forward in half of the states with a new deadline. 

As of December 28, 2021, CMS is moving forward with the mandate in twenty-five states (and Washington D.C.). According to CMS’ updated guidance, a covered facility must develop a vaccine procedure and have their staff receive at least the first dose of the vaccine by January 27. By February 28, the facility will need to have a fully vaccinated staff. 

3.    Federal Contractor Vaccine Mandate Executive Order 14042
Enforcement status: NOT ACTIVE

EO 14042 requires all federal contractors to have a fully vaccinated staff. Although this mandate does not directly apply to DMEPOS companies, this mandate can be extended to subcontracted suppliers. As of December 7, 2021, EO 14042 has been paused by a federal judge in Georgia. 

In addition to the above federal mandates, DMEPOS companies should be mindful of state and local-level vaccine requirements.

CMS Updates Face-2-Face & WOPD Requirements

 After nearly two years without any changes, CMS announced updates to the Master List of DMEPOS Items Potentially Subject to Face-to-Face Encounter and Written Order Prior to Delivery and/or Prior Authorization Requirements today. CMS added 31 HCPCS to the Master List, deleted five HCPCS from the Master List, added 11 HCPCS to the Required Prior Authorization List, and seven new codes to the F2F and WOPD Required List. The Master List includes items that meet CMS’ criteria to be added to the Prior Authorization program, and/or F2F and WOPD Required List.  Being added to the Master List does not mean the HCPCS will be added to the two required lists, it just means that CMS has the option to include it in the future. The 11 HCPCS added to the Prior Authorization List include the following:
 The implementation of the newly added Prior Authorization HCPCS will be phased in 3 stages:
  • Phase 1 (April 13, 2022): Implement in California, Florida, Illinois, and New York
  • Phase 2 (July 12, 2022):  Implement in Maryland, Pennsylvania, New Jersey, Michigan, Ohio, Kentucky, Texas, North Carolina, Georgia, Missouri, Arizona, and Washington 
  • Phase 3 (October 10, 2022): Nation-wide implementation
With this notice, CMS officially published the F2F and WOPD Required List. The list includes 46 power mobility device codes that are statutorily required to have a F2F and WOPD, plus six orthotic codes and one osteogenesis codes that are not statutorily required. The F2F and WOPD requirements are effective beginning April 13, 2022. Due to the flexibilities under the Public Health Emergency, the F2F encounter can be done either in-person or telehealth. 

You can find the updated Master and Required Lists below: 

Illinois Bill to Repeal Breast Pump Sales Tax Introduced  

A subgroup of the Breast Pump Policy Coalition has engaged lobbyists in Illinois to assist with repealing the sales tax for breast pumps. Efforts are already underway! Senator Barbara Hernandez introduced H.B. 4234 which would allow breast pumps, breast pump collection and storage supplies, and breast pump kits to be exempt from the taxes imposed beginning on July 1, 2022. The bill now has 14 cosponsors and was referred to the Rules Committee on the opening day of the legislative session, January 5. 

Currently, only eight states in the US exempt sales tax for breastfeeding equipment, while  infant formula is generally tax-free. A handful of states have limited exemptions, where pumps are exempt subject to certain stipulations. This isn’t a true solution and doesn’t ease the tax burden on most moms. Full sales and use tax exemption for breast pumps and supplies is the key to reducing this tax burden.

The campaign will include reaching out to breastfeeding coalitions and other organizations who would be willing to support the legislation through social media and calls to legislators. A companion bill is expected in the Senate shortly.


If you would like further information about this initiative, please visit parityforpumps.com/illinois. If you are interested in supporting these efforts, please reach out to Tilly Gambill, director of marketing communications, tillyg@aahomecare.org

DME Represents 1.35% of Medicare Spend 

The Department of Health and Human Services released the latest 2020 Medicare expenditures data, reporting that DME accounts for 1.35% ($11.2 billion) of total Medicare spend.  In the past ten years, total Medicare spending rose 1.5 times more than DME spending.  HME stakeholders are encouraged to use AAHomecare’s updated Medicare Spending Chart advocacy document, available here, when engaging federal legislators on the need to address reimbursement challenges.  The document illustrates how DME is not part of the problem with Medicare expenditures and instead provides a cost-effective solution.  DME, supplies, and services enable millions of Americans to remain safe and independent at home and is an essential tool to keeping the overall health care costs down.                                                        

Parachute Health Is Latest AAHomecare Diamond Partner     

DME ePrescribe company Parachute Health has reaffirmed its commitment to the provider community as AAHomecare’s newest Diamond-level corporate partner.

“We’re gratified to see another highly regarded company step up their support for high-impact DME public policy efforts at a critical time for this industry,” said Tom Ryan, AAHomecare president and CEO. “Forward-thinking DME stakeholders like Parachute Health see the opportunity to improve the reimbursement and regulatory environment for our industry and are demonstrating their commitment to making that a reality.”

“Increased adoption of DME ePrescribing benefits providers and patients alike,” added Ryan. “Having multiple strong platforms operating in this space will lead to further innovation and better solutions serving an increasingly important component of the healthcare continuum.”

Parachute Health has a significant market presence with over 110,000 MDs signing digital orders on the platform, helping patients nationwide receive their medical equipment & supplies on time, especially during a pandemic.  See more details in our press release and Parachute Health’s announcement, or visit parachutehealth.com.

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April 4-6, 2022 - Phoenix Convention Center

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With 40+ expert-led educational sessions and special workshops to choose from and the chance to connect with leaders from across the country, Medtrade West represents the best value for collecting new resources and perspectives to strengthen your company for the rest of 2022 and beyond!  Register today!

Medtrade West Resources

Federal Law Governing Medicare Advantage Plans and Medicaid Managed Care Plans

Webinar Presented by Jeffrey Baird, Esq. of Brown & Fortunato
January 25, 2022 | 2:30-3:30 PM ET


Medicare Advantage Plans (“MAPs”) and Medicaid Managed Care Plans (“MMCPs”) have become an important part of the lives of DME suppliers. Approximately 70% of Medicaid patients are covered by MMCPs, while approximately 39% of Medicare beneficiaries are covered by MAPs. These percentages will continue to increase.

Working with MAPs/MMCPs is frustrating for suppliers. MAPs/MMCPs are heavy handed on a number of fronts. And so DME suppliers quite naturally ask what the federal laws are that govern MAPs/MMCPs. On the one hand, federal laws governing MAPs/MMCPs are quite extensive. However, only a small portion of the federal laws pertain to the relationship between the MAPs/MMCPs and the providers/suppliers that serve the patients covered by the plans. Much of the law is aimed to (i) protect covered lives and (ii) set minimum requirements for coverage, networks, complex reimbursement mechanisms.

This program will discuss the federal laws that govern MAPs and MMCPs. Equally as important, this law will discuss how these laws affect DME suppliers as they provide services to patients covered by MAPs and MMCPs. 
Register Here

AAHomecare in Action

Tom Ryan, president & CEO, Jay Witter, senior vice president of public policy, Kim Brummett, vice president of regulatory affairs, and Gordon Barnes, senior director of communications, met with the FDA regarding CPAP/BIPAPs…Witter met with Rep. Sharice Davids (D-KS) regarding the chip shortage…Laura Williard, vice president of payer relations, participated in the OAMES Board of Directors Meeting, PAMS Legislative Committee Call, and the SCMESA COVID-19 Payor Update call…David Chandler, senior director of payer relations, participated in NEMEP’s Legislative Strategy call as well as met with Empire Health Plan, met with Virginia Medicaid and ACMESA, Virginia legislative strategy meeting, and TexMEP’s legislative committee call…Brummett and Mina Uehara, director of regulatory affairs, met with a subgroup of the Regulatory Council to discuss transitions post-PHE…Williard and Tilly Gambill, director of marketing communications, met with the Illinois lobbyist regarding HB 4234…
 
AAHomecare’s Payer Relations NIV Workgroup, State Leaders Council, Breast Pump Coalition, and the Regulatory Council’s Oxygen CDE Subgroup convened…
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