A Year in Review: 2021 Can be Summed Up in One Word - Resilience!

Published in Government Relations on January 05, 2022

While it is true that our industry, and all industries for that matter, face challenges on several fronts, we should take stock in the amazing service, support, and products that our community was able to provide to those in need! Your focus on the patient was never more needed, and each of you rose to the challenge. As you battle through supply shortages, uncertain healthcare policies, public health emergencies, and crazy weather in multiple regions across the county, you continue to show why our industry is a vital component to patient health success and continues to gain visibility in the home healthcare space.

It is in response to your amazing work that the VGM Government Relations team doubled down on its efforts to support our industry, raise up your voices, and go boldly into the issue debates with local, state, and federal policy makers. This “year in review” highlights topics through which your VGM Government Relations team walked side-by-side with you to ensure that our industry has a voice, that your concerns are heard, and that your victories are recognized. From standing up to highlight the need for equitable reimbursement, to showcasing the patient nees you are fulfilling even as supply shortages persist, VGM stands with you to ensure that your voice is heard from state capitals to the nation’s capital.

Let’s take time to reflect on 2021.

Reimbursement Concerns and Regulatory Challenges

Ask any home medical equipment (HME) supplier what they wanted for Christmas, and almost all will respond with increased reimbursement and relief from regulatory burdens. Prices of goods continue to rise, but Medicare reimbursement for home medical equipment has been in the same state for many years.

On December 22, 2021, CMS released the long-awaited final rule (CMS-1738-F) relative to post-pandemic DMEPOS fee schedule adjustments. Click here to view an in-depth review of the DME Final Rule from Mark Higley.

The Forgotten Healthcare Workers During the COVID-19 Pandemic

The HME providers are working tirelessly to help COVID-19 patients heal at home with necessary equipment such as home ventilators, oxygen, CPAP/BiPAPs, and hospital beds. They are working early in the morning and late at night, making deliveries out of their normal scope of services to take care of patients, all while continuing to provide necessary supplies and equipment to the elderly and ill without the coronavirus diagnosis.

Sadly, HME suppliers were not considered a priority in receiving personal protective equipment (PPE) and vaccines, as was the case with hospital workers. In December of 2021, we surveyed our members on the PPE expenditures during the COVID-19 pandemic. Mark Higley was able to quantify these results into an approximate number of dollars spent on PPE within the DME industry. The results of this survey have been sent to congressional offices. Click here to view Mark’s analysis on PPE expenses for DME providers.

We continue to encourage congress to understand the importance of HME during this pandemic.

Medical Equipment is Not Immune to Supply Shortages

We’ve all seen on the nightly news with images of cargo ships with containers of goods sitting, waiting to be received and distributed throughout the country. Much of reports in November and December were about Christmas gifts, and if we would be able to get our gifts to families in time for the holidays. But it’s not just Christmas toys and home goods on those boat; critical home medical equipment is also waiting to be distributed.

Here is just one of many stories of how the supply chain shortages are having a harmful effect on patients in severe need of HME: https://calmatters.org/health/2021/11/medical-supplies-shortage-california/

Vaccine Mandate - More Clarity to Come After January 7

On January 7, the Supreme Court will hear arguments on both the CMS federal mandate for healthcare workers as well as the OSHA mandate for employers with 100 or more employees. Keep a watchful eye out for more information from the VGM Government Relations team on this as it will affect many of your businesses.

As of December 30, 2021, the OSHA mandate remains blocked across the country, while the CMS mandate for healthcare workers is blocked in 25 states, but enforceable in the other 25. Once the Supreme Court hears the arguments and makes their ruling, we should (hopefully) have clarity regarding the status of each of these vaccine mandates.

Additional information about these mandates can be found here:

OSHA: https://www.osha.gov/coronavirus/ets2

CMS: https://www.cms.gov/About-CMS/Agency-Information/Emergency/EPRO/Current-Emergencies/Current-Emergencies-page

Industry Events! In-Person and Virtual

Some of us may be a bit reluctant to spend an entire day in virtual meetings, but where would we be this past year if we didn’t have all the virtual capabilities as we do now? Many HME conferences were held virtually this past year, and many of the state associations were still able to be profitable from these events.

The VGM Heartland Conference and both Medtrade Spring and Fall were back in-person this year, all with the similar theme of, “It’s nice to be back.” Hopefully 2022 will allow more of these events in-person again. Planning is already underway for the next VGM Heartland Conference, returning to our normal time of the year from June 13-15, 2022. We hope to see all of you there!

Grassroots Efforts Despite the COVID-19 Restrictions

While COVID-19 restrictions kept us from having many in-person meetings, we were still able to gain traction with new and old HME champions, thanks to the help of state associations and many of our VGM members.

Rep. Markwayne Mullin (R-OK) - Thanks to the relationships established by OMEPA members, Rep. Markwayne Mullin has agreed to be a champion for the HME industry! Rep. Mullins sits on the House Energy and Commerce Committee.

Rep. Terri Sewell (D-AL) - ADMEA has done a fantastic job of keeping all of their members of Congress updated regarding several HME issues. Rep. Terri Sewell sits on the House Ways and Means Committee. She is also on the task force for Rural and Underserved Communities, which is why she has a keen interest in accessibility to HME to patients in need. The VGM Government Relations team, along with ADMEA members, have been keeping her health staff updated via virtual meetings throughout the year.

Rep. Jodey Arrington (R-TX) - Mr. Arrington also serves on the House Ways and Means Committee, as well as the Rural and Underserved task force. John Gallagher has met with Rep. Arrington in-person and over the phone this year. We are working on scheduling an event with TexMEP and Rep. Arrington early this year.

Rep. Cathy McMorris Rodgers (R-WA) - With next year’s midterm elections, there is a chance our longstanding HME champion will hold the Chairmanship of the Energy and Commerce committee. For that reason, she suggested we find alternate champions to lead bills as chairmens oftentimes are not able to be the lead supporter of a bill. This was discussed with Rep. McMorris Rodgers in-person at an event in Idaho this past fall. John Gallagher, Jim Kissler of Norco, Jay Witter of AAHomecare, and Seth Johnson of Pride were all able to attend and strategize with Rep. McMorris Rodgers in-person. The HME industry is truly appreciative of all the support Rep. McMorris Rodgers has given, and also appreciative of PAMES and Big Sky AMES state associations for building and maintaining this relationship.

(Jay Witter, Seth Johnson, John Gallagher, Rep.McMorris Rodgers, and Jim Kissler)

Legislative Efforts in 2022

Now with the DMEPOS Final Rule finally out, and the fact that the Final Rule has not deviated that much from the CMS Proposed Rule, the industry can move forward with our champions, Rep. Cathy McMorris-Rodgers (R-WA), Rep. Markwayne Mullin (R-OK), and Rep. Paul Tonko (D-NY) on Energy & Commerce, to bring forth legislative language to address:

• Legislation that will provide additional relief to HME providers, particularly those that service patients outside of competitive bidding areas in non-rural areas by extending the Cares Act 75/25 blend at least through the next round of CBP in 2023/24.
   
• Legislation to extend the non-rural blended rate – 75/25 to those of Competitive Bidding Areas (CBA). Just because a beneficiary’s zip code is in Boise or any other Competitive Bid Area, they should not be subjected to access issues due to no relief with a blended rate.
   
• Legislation that will correct/improve the competitive bidding program. Currently, the next round of Competitive Bid is unlikely until at least 2024 - if then. In the meantime, providers are stuck with Competitive Bid Rates from 2016. With supply chain/inflationary issues, those rates are unattainable until CMS figures out what they plan to do. CMS has failed with the Competitive Bidding Program on three different bids. Congress needs to step in and direct CMS with a workable Competitive Bidding Auction system that works. The industry/VGM has been working on just such an alternative auction with Dr. Ken Brown and the Economics Department at Missouri State University.

Complex Rehab Technology (CRT)

This year there was a significant win in the CRT industry with CMS making manual wheelchair accessories permanently exempt from the competitive bidding program!

“This is indeed good news for providers of complex rehab technology. While this is big win for CRT providers, it is huge for end users. This will result in the overall reduction of healthcare cost with proper seating and positioning for beneficiaries,” said Greg Packer, president of U.S. Rehab.

Tom Powers of VGM Government Relations and Greg Packer and the U.S. Rehab team will continue to encourage members of Congress to support legislation that will improve the lives of wheelchair end users. Priorities for this year include:

• Obtaining Medicare coverage for power standing and seat elevation systems
• Continue to develop CRT outcomes data (FMA) and use information in advocacy for legislation with real data
• Continue pursuing CRT Access, formerly known as Separate Benefit Category

Orthotics and Prosthetics

Tom Powers and Todd Eagen, president of OPGA, will continue pursuing HR 1990 and S 2556, the Medicare Orthotics and Prosthetics Patient-Centered Care Act, in 2022. Tom and Todd were thrilled to have such great leaders in support of this bill, including Sens. Mark Warner (D-VA), Steve Daines (R-MT), Chuck Grassley (R-IA), and Tammy Duckworth (D-IL).

The bill requires suppliers of orthotics and prosthetics to meet certain standards with respect to licensure and accreditation, physical facilities, and liability insurance. Orthotists and prosthetists may also issue written orders for commercial purposes that meet specified standards; such orders must be signed by the treating physician.

The bill also prohibits payment under Medicare for certain prosthetics and orthotics that are delivered via drop shipment (i.e., direct shipment to a beneficiary who has not received corresponding patient care from a health care practitioner).

Women’s Health

Tom Powers and Nikki Jensen, vice president of Essentially Women, have been actively working to gain support of congress to allow coverage for L8035, custom breast prosthesis, with bills HR 3087 and S 2051. The overall objective is to ensure women seeking breast replacement options have the options available to them. One in eight women will be diagnosed with breast cancer during her lifetime. As with all legislation, it has been difficult to get scores on individual bills and the path for a vehicle to move. Tom, Nikki, and the team are not giving up on CMS and the possibility of passing this bill through smaller bills this year.

Live at Home

Tom Powers will continue to work with VGM Live at Home on legislation that will allow use of a 401K or IRA savings without tax or penalty for aging in place home modifications. In the past year, Tom and Jim Greatorex, vice president of VGM Live at Home, have been yielding very positive feedback on both sides of the aisle and solid champions. They have even recruited the help of former Iowa Senator Tom Harkin. We’re looking forward to moving this legislation forward in 2022.

Our ask for you

Patients healing at home is more important than ever right now. The need for quality DMEPOS suppliers is paramount. Throughout the next year, we will continue to ask you to speak up about these concerns, protect the integrity of the medical equipment and service industry, and support legislation that will provide some much-needed reimbursement relief to keep home medical equipment suppliers alive and working. There will always be a need for HME. There will always be a need for you!

Please join us in 2022 as we continue to fight for accessibility and fair reimbursement for quality goods and services. While there is work to be done and continued challenges yet to overcome, we salute you, we stand with you, and we thank you. Thank you for all you have done in 2021, and thank you for all that we will do together in 2022.

TAGS

1. cms
2. competitive bidding
3. complex rehab
4. covid-19
5. medicare
6. osha
7. phe
8. ppe
9. regulatory