Editor's Note

Rekindling HME's Hope

Despite July's setbacks, the fight's far from over.

• By David Kopf
• Aug 01, 2016

“No one ever said it would be easy, but they never said it would be so hard.” My mental stereo has had those lyrics stuck on repeat for the past several days. As I write this, the industry is still reeling from the absolute shock of rural relief stalling out in the Senate.

As you've read in recent news stories on this site, and perhaps in "The Rural Relief Rethink," the hard work and dedicated advocacy done by the staff and members of the American Association for Homecare, the state associations’ staff and members, the VGM Group, various manufacturer government relations experts, and rank and file providers from across the country was completely sidetracked by not one, but two completely frustrating and completely unexpected events.

The whole story is illustrative of both the constant roadblocks the industry must contend with, and the dedicated, undaunted attitude of HME’s advocates.

Who could have predicted that the House’s initial rural relief vote would get shut down by Democratic lawmakers’ sit-in in the wake of the Orlando, Fla. terrorist shooting? But, despite the fact that such a development meant that rural HME providers and their patients would have to suffer full reimbursement cuts on July 1, the industry kept pushing to get legislation passed after the fact.

And who could have predicted that, after the House passed that follow-up legislation and the Senate then hotlined a companion bill — usually a fast track to approval — that those efforts would be undermined by a single Senator’s last-minute hold late on the afternoon before the Senate was to recess for the summer?

What are the chances of those two things happening in such quick succession for the same legislative effort? Mind you, that’s not a rhetorical question. I really want to know the answer, because if the odds are long enough, I suggest we all get together and start a lottery pool. The next Powerball jackpot is calling our name. Heck, we’re due; that’s for sure.

All jokes aside, I’m not going to lie — what happened to rural relief was frustrating beyond compare. I’m talking the gnashing your teeth and pulling your hair kind of frustration. The kind of frustration that makes you want to give up all hope.

But don’t do it. You need to get past the frustration and stoke whatever small, smoldering embers of hope you have remaining. We all need to, because, simply put, the fight is not over.

I know that sounds crazy, with the July 1 rate cuts now in full effect, but things don’t have to stay that way. As you’ll read in this issue’s coverage, the industry’s leadership and advocates are already working with legislative champions in the House and Senate to shape a new legislative strategy that they can advance between when both chambers reconvene in early September and the next elections.

And while they’re doing that, they desperately need providers and patients to contact their Representatives and Senators to share their frustration and reassert how vitally important it is to protect rural access to HME. Maintaining that “noise level” ensures that lawmakers will understand the issue is not.

And for an industry that has seen so much vexation, asking for help on yet another legislative effort sounds like a tall order. If it feels like you just can’t summon up any hope to get you motivated to support that effort, here are three thing that should help you muster a more positive outlook on the situation:

1. The industry succeeded in getting binding bids legislation passed last year in order to eradicate the scourge of suicide bidding. That’s a crucial victory. In addition to requiring bidders to maintain state licensure, the legislation requires bidders to obtain a “bidding bond” that functions like a surety bond. This way, if a bidder declines the contract and its bid was at or below the bid price, then that bidder would forfeit its bond.

2. CMS just proposed a rule would shift the bid ceiling to the 2015 fee schedule. That’s huge. The rule would ensure that bids always have a fixed ceiling, rather than dwindle reimbursement down to nothing by using each successive re-compete as the ceiling for the next re-compete. CMS essentially agreed with the industry, by stating in the proposed rule’s language that setting the ceiling to pre-bid levels ensured the program’s long-term viability — the exact argument the industry has made for some time.

3. The industry is in a very good position to resume the rural relief fight after lawmakers return to Capitol Hill in September. We can’t forget that despite the two surprise setbacks that stalled out rural relief, the industry succeeded in getting rural reform passed — twice. And in under a month, no less. The political will among lawmakers to protect rural HME access is undeniable, and that will give the industry a serious head start come September.

I don’t know about you, but those three facts put July’s setback in an entirely different light. Yes, it’s frustrating, but the fight’s clearly not over, and the majority of lawmakers in both chambers are not only on our side, but share our perspective. We all have good reason to take hope and keep fighting.

This article originally appeared in the August 2016 issue of HME Business.