Congressmen Sponsor Bill to Strike MMA’s DME Cuts
In June, Representative David Hobson (R-Ohio) and Representative Harold Ford, Jr (D-Tenn) introduced HR 4491, a bill that would repeal reductions in Medicare reimbursement for certain DME items. The cuts—scheduled to take effect in January 2005—are part of the Medicare Prescription Drug, Improvement, and Modernization Act (MMA) of 2003 and would lower pricing for oxygen, manual wheelchairs, power wheelchairs, nebulizers, diabetic supplies, and air mattresses to the levels of the Federal Employees Health Benefits Program (FEHBP).

“I am committed to making sure that seniors who depend on durable medical equipment will continue to have access to the equipment and services they rely upon so they can maintain the highest quality of life while staying in their homes,” Hobson says.

The difference between FEHBP pricing and the 2002 Medicare allowable ranges from 3% to 20%, according to a report compiled by the VGM Group of Waterloo, Iowa.

The American Association for Homecare (AAHomecare), which applauded the introduction of the bill, says that basing Medicare rates on the FEHBP is inappropriate because the federal employee plan serves “a younger, healthier population and imposes fewer administrative burdens on providers.”

Since the association’s legislative conference in early June in Washington, DC, at least nine more representatives have signed on to co-sponsor the bill.

AAHomecare Converges on Washington, DC
On June 7-9, American Association for Homecare (AAHomecare) members attempted to break the election-year inertia by rallying the faithful at the 2004 Washington Legislative Conference. They discussed reimbursement issues, networked with peers, and took their case to more than 200 members of Congress. All told, home-district delegations from AAHomecare met with congressional members and staff from 34 states.

Among the top priorities was the issue of basing Centers for Medicare and Medicaid Services (CMS) reimbursement for certain DME items (oxygen/oxygen equipment, diabetic supplies and strips, wheelchairs, beds, and nebulizers) on the Federal Employees Health Benefits Program (FEHBP). Members argued that the new provision (set to begin in January 2005) was hastily added to the Medicare Prescription Drug, Improvement, and Modernization Act (MMA) of 2003 and does not accurately reflect the true costs for the Medicare population.

During their meetings with members of Congress, AAHomecare members sought cosponsors and companion legislation in the Senate for HR 4491, which was recently introduced by Reps David Hobson (R-Ohio) and Harold Ford, Jr (D-Tenn) to repeal those reimbursement cuts. “AAHomecare has been working hard to educate policymakers about the negative impact of the pricing changes in MMA and the bill introduced by Rep Hobson and Rep Ford represents a great step forward for patients who need home care therapies and equipment and for the organizations that provide them,” said Kay Cox, president and CEO of AAHomecare.

Conference attendees heard from a series of experts, including a panel of key congressional staff moderated by former CMS administrator Tom Scully. Most of the panelists agreed that there was little chance this year for legislative remedies to address FEHBP pricing or the “average sales price (ASP) plus 6%” for respiratory medication and supplies. Other experts were hopeful that HR 4491 could get attached to another legislative vehicle later this year—if enough congressional members sign on as cosponsors. Panel members did leave some hope that CMS may allow a small dispensing fee to offset “immediate shortages” caused by ASP plus 6%.

Kay Cox, president and CEO of AAHomecare (left), looks on as Sen Mike Crapo (R-Idaho) addresses the FEHBP reimbursement issue at this year’s AAHomecare Washington Legislative Conference.

Senators Mike Crapo (R-Idaho) and Blanche Lincoln (D-Ark) also addressed the 200-plus attendees at the legislative conference. Senator Crapo discussed the importance of home care in the efficient delivery of high-quality health care for Americans and specifically addressed the FEHBP reimbursement problem. The senator also discussed his involvement in the new congressional chronic obstructive pulmonary disease (COPD) caucus, which he founded to advocate for policies that encourage prevention and detection of COPD. He said COPD is “quickly becoming one of our major health care crises.”

Senator Lincoln, also a member of the COPD Caucus, talked about her personal experience with home care during her father’s struggle with Alzheimer ’s disease and discussed several reimbursement issues facing home care providers and manufacturers. After praising the value of home care, Lincoln added, “But you can’t do it just out of the goodness of your own heart.”

John Greene, legislative director of the National Association of Health Underwriters, spoke about a variety of underwriting issues, including the importance of long term care insurance as a means of preserving consumers’ choice of home care as a cost-effective and preferred alternative.

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AAHomecare Converges on Washington, DC continued
On June 7-9, American Association for Homecare (AAHomecare) members attempted to break the election-year inertia by rallying the faithful at the 2004 Washington Legislative Conference. They discussed reimbursement issues, networked with peers, and took their case to more than 200 members of Congress. All told, home-district delegations from AAHomecare met with congressional members and staff from 34 states.

Among the top priorities was the issue of basing Centers for Medicare and Medicaid Services (CMS) reimbursement for certain DME items (oxygen/oxygen equipment, diabetic supplies and strips, wheelchairs, beds, and nebulizers) on the Federal Employees Health Benefits Program (FEHBP). Members argued that the new provision (set to begin in January 2005) was hastily added to the Medicare Prescription Drug, Improvement, and Modernization Act (MMA) of 2003 and does not accurately reflect the true costs for the Medicare population.

During their meetings with members of Congress, AAHomecare members sought cosponsors and companion legislation in the Senate for HR 4491, which was recently introduced by Reps David Hobson (R-Ohio) and Harold Ford, Jr (D-Tenn) to repeal those reimbursement cuts. “AAHomecare has been working hard to educate policymakers about the negative impact of the pricing changes in MMA and the bill introduced by Rep Hobson and Rep Ford represents a great step forward for patients who need home care therapies and equipment and for the organizations that provide them,” said Kay Cox, president and CEO of AAHomecare.

Conference attendees heard from a series of experts, including a panel of key congressional staff moderated by former CMS administrator Tom Scully. Most of the panelists agreed that there was little chance this year for legislative remedies to address FEHBP pricing or the “average sales price (ASP) plus 6%” for respiratory medication and supplies. Other experts were hopeful that HR 4491 could get attached to another legislative vehicle later this year—if enough congressional members sign on as cosponsors. Panel members did leave some hope that CMS may allow a small dispensing fee to offset “immediate shortages” caused by ASP plus 6%.

Senators Mike Crapo (R-Idaho) and Blanche Lincoln (D-Ark) also addressed the 200-plus attendees at the legislative conference. Senator Crapo discussed the importance of home care in the efficient delivery of high-quality health care for Americans and specifically addressed the FEHBP reimbursement problem. The senator also discussed his involvement in the new congressional chronic obstructive pulmonary disease (COPD) caucus, which he founded to advocate for policies that encourage prevention and detection of COPD. He said COPD is “quickly becoming one of our major health care crises.”

Senator Lincoln, also a member of the COPD Caucus, talked about her personal experience with home care during her father’s struggle with Alzheimer ’s disease and discussed several reimbursement issues facing home care providers and manufacturers. After praising the value of home care, Lincoln added, “But you can’t do it just out of the goodness of your own heart.”

John Greene, legislative director of the National Association of Health Underwriters, spoke about a variety of underwriting issues, including the importance of long term care insurance as a means of preserving consumers’ choice of home care as a cost-effective and preferred alternative.

AAHomecare Welcomes Board Members
The American Association for Homecare (AAHomecare) recently chose its 2004-2005 officers of the Board of Directors. Tim Pontius, former vice chair for AAHomecare, is now AAHomecare chair. Pontius is president and CEO of Young Medical Services in Toledo, Ohio. Tom Ryan, president and CEO of Homecare Concepts, Farmingdale, NY, and AAHomecare legislative committee chair, has been elected vice chair.

Other officers include Larry Higby, president and CEO of Apria Healthcare Group—treasurer; Todd Brason, CEO of Willcare Inc of Buffalo, NY—secretary; Joel Mills, president and CEO of Advanced Home Care, Greensboro, NC—immediate past chair (also chair of the nominating committee).

AAHomecare also recently appointed two new staff members, Martha Rinker, vice president for government relations, and Michael Reinemer, director of communications. Before joining AAHomecare, Rinker served as legislative counsel at the American Podiatric Medical Association and as director of government relations at the American Orthotic and Prosthetic Association. Reinemer previously was director of communications at the National League of Cities and the National Council on the Aging.