The Independence through Enhancement of Medicaid and Medicare (ITEM) Coalition, made of the more than 30 advocacy organizations that support people living with disabilities, including the Amputee Coalition, sent a letter to Congressional leaders in support of the reinstatement of the Medicare 75/25 blended reimbursement rate for home medical equipment. The ITEM Coalition noted that the expiration of the 75/25 reimbursement rate in January has hurt patient access to durable medical equipment (DME) nationwide, 75 percent competitive bid rate/25 percent unadjusted Medicare fee schedule rates.
The cuts are the result of the Durable Medical Equipment, Prosthetics, Orthotics, and Supplies (DMEPOS) competitive bidding program (CBP), which does not reflect the current market costs of providing care, according to ITEM Coalition member AAHomecare.
“Without action from Congress or the Centers for Medicare & Medicaid Services (CMS) to provide relief from the unsustainable nature of these reductions in reimbursement, many DMEPOS suppliers and providers will not be able to remain viable, and millions of Americans with disabilities will be at high risk of diminished access to care.”
The group also voiced “long-standing concerns” about competitive bidding and the contention that the program has limited access to home medical equipment over the years, has limited equipment choice, and has therefore reduced quality of care.
“In 2018, CMS paused the CBP because of design flaws that caused unsustainable payment rates resulting in access issues for Medicare beneficiaries who need DMEPOS services,” the letter said. “CMS used the two-year pause to redesign the program.”
In the years that followed, however, home medical equipment providers continued to be reimbursed at outdated rates, the letter said. “Unfortunately, CMS maintained the previously flawed payment rates that were established in 2016 during the pause, which were 50-60 percent lower than the unadjusted Medicare fee schedule rates. Congress and CMS have intervened numerous times through the years to provide additional relief, most recently providing a 75/25 blended rate for non-bid, non-rural areas through 2023….
“While not ideal, this 75/25 blended rate was a much-needed lifeline for DMEPOS suppliers and providers, and afforded beneficiaries continued access to the level of care and services that they needed.”
When the 75/25 blended rate expired on January 1, the result was “a 20 percent fee reduction across the top 25 DME [Healthcare Common Procedure Coding System] codes, dealing a crushing blow to DMEPOS suppliers and providers, threatening to decimate the infrastructure that enables Medicare beneficiaries with disabilities and chronic conditions to manage their medical and functional needs at home.”
The letter urged support for bills in the House and Senate to “provide relief from the devastating impact that these reimbursement reductions are creating across the country.”
ITEM Coalition members referred to H.R. 5555, the DMEPOS Relief Act, “which would provide a 90/10 blended Medicare reimbursement rate (90 percent adjusted payment rate/10 percent unadjusted fee schedule rate) for most home medical equipment products in competitive bidding areas. This bill would also extend the 75/25 blended rate that expired in January for non-rural/non-CBA [non-competitive bid area] suppliers and providers for a specified length of time.”
The letter also referenced S. 1294, the Competitive Bidding Relief Act, “which would extend the 75/25 blended Medicare reimbursement rate for suppliers in non-rural, non-CBAs through a specified length of time. While these are not companion bills, provisions from each bill would help ameliorate the negative impacts of this situation going forward.
“The ITEM Coalition respectfully urges both House and Senate leadership to include provisions from these bills in any legislative package that moves prior to the end of the 118th Congress in order to preserve and protect access to affordable, timely and quality home medical equipment for Medicare beneficiaries.”
The ITEM Coalition also includes the ALS Association, the Association of Rehabilitation Nurses, the Brain Injury Association of America, the Christopher & Dana Reeve Foundation, and the Clinician Task Force, among others.
To read the letter, visit the “ITEM Coalition Letter in Support of DME Access” on the AAHomecare website.
