Observation Deck

A Washington Agenda for 2014

Key issues facing providers and patients this year, and the opportunities to address them on Capitol Hill.

• By Seth Johnson
• Dec 19, 2013

As we look to 2014, it is important to look back at what transpired in 2013 to best assess the opportunities and threats for the coming year. Clearly as the baby boomers continue to move into the Medicare program at a significant rate, the market for HME will continue to expand. The past year certainly presented the industry with its share of challenges from competitive bidding to audits to Medicaid; however, opportunities should exist in 2014 to improve the landscape and improve outcomes. While many important issues will impact the industry, four areas will be a primary focus:

Competitive Bidding

While a minor amendment was agreed to during the Senate Finance Committee SGR/Doc fix legislation markup at the end of the year to require out of state providers to prove they are licensed at the time of bid submission, the Market Pricing Program alternative or more substantive reforms to the program were not included. Being in the Senate bill is good in that an opportunity exists to strengthen the competitive bidding amendment as it moves through the process in the first quarter of the year.

The industry built significant support for the MPP alternative in 2013, and increasing awareness of the problems and support for the legislation will continue to be needed to compel Congress to take action. The good news is, support to address the program has never been stronger for an alternative to fix the most egregious flaws within the current program and require Medicare to follow its own licensing and accreditation rules. That said, we must remain focused on efforts to get beneficiaries, hospitals, physicians and discharge planners more engaged in raising concerns about the competitive bidding’s impact in order to secure the necessary relief from the flawed program.

Separate Benefit for Complex Rehab Technology

The complex rehab industry has never been better positioned to pass legislation to create a separate benefit category for complex rehab. Senator Chuck Schumer (D-N.Y.) sponsor of S.948, the Senate companion to H.R. 942, attempted to include this legislation during the Senate Finance Committee markup the end of the year. While that attempt was not successful, it underscores his commitment to getting this important legislation passed into law. There will likely be another opportunity in early in 2014 to include the bill to the broader SGR/Doc fix legislation.

This legislation is designed to improve and protect access to Complex Rehab Technology (CRT) products and services for individuals with significant disabilities and medical conditions. Among other things, the legislation would further protect the complex rehab technology industry from future arbitrary payment reductions and provide a more formal mechanism for future payment enhancements. Once the legislation is passed, the rather lengthy regulatory process will follow. This will remain be a big industry focus in 2014. For the latest information on this initiative go to www.access2CRT.org.

CMS E-Doc Initiative

The electronic Determination of Coverage (eDoC) workgroup is a collaborative effort between CMS, the Office of the National Coordinator for Health Information Technology (ONC) and industry stakeholders. The goal is to create tools that will facilitate provider documentation of a patient’s condition and enable the coordination of communication between providers (e.g.- between the physician and the Licensed Clinical Medical Professional (LCMP), the Durable Medical Equipment (DME) supplier, and payer entities to determine coverage for power mobility devices.

The (eDoC) power mobility device (PMD) user story was approved on Oct. 30, 2013, which allows the project to proceed toward preparation for the pilot phase. The PMD user story is the framework that addresses the data requirements necessary for determination of coverage and necessary to support a claim for a power mobility device sent to a payor. It does not include the specifics of the e-Clinical template, but it does outline the complex components required to proceed with the project.

The purpose of the pilot phase is to implement the technology in realworld situations and aid in learning the policies that will be required for an operational system, identify barriers for implementation, and revise reference implementations and harmonized specifications based on real-world lessons learned, according to the Standards and Interoperability framework. At the time of this writing no set dates for the rollout have been published but it is expected to occur in 2014. Additional information on the pilot program is available at wiki.siframework.org.

Medicaid

Challenges will continue to present themselves at the state level as legislatures continue to look for ways to reduce expenditures, or slow the growth of their Medicaid programs. The industry is much more organized and has made some progress in certain states due to increased industry efforts on Medicaid issues. In 2014, many state legislators will also be up for re-election, which should result in them being more attuned to concerns or issues raised by constituents. They will be looking for ways to help, and there are certainly things they could do to facilitate improvements within the Medicaid program.

Since all states have somewhat unique and individual Medicaid programs, the best resource for the latest information is your state association and organizations like NCART on the complex rehab front. Each has resources to get stakeholders more involved in helping protect Medicaid coverage and payment policies that may be under discussion for further reductions.

Clearly it is going to be another busy year, ripe with opportunities to further advance positive outcomes for the industry as the market continues to expand. If we as an industry continue to build on the significant education and lobbying efforts with policymakers, legislators, consumer groups, clinician groups, and other stakeholders, I am confident 2014 will be a better year for the industry.

This article originally appeared in the January 2014 issue of HME Business.