On Sept. 13, 2016, Congressman Larry Bucshon, M.D. of Indiana introduced H.R.6012, a companion bill to S.3195, known as the BREATH Act of 2016 (or the Beneficiary Respiratory Equipment Access and Transparency to Home ventilator Care Act of 2016). These bills will push CMS to develop practical medical necessity guidelines and payment amounts for ventilators. Payment rates will increase in 2017 contingent upon an expected drop in ventilator claims as a result of more defined medical necessity standards. If ventilator claims do not decrease, more cuts may be necessary in 2018.
Meanwhile, the DME Relief bills are still pending for escalation. The current holdup appears to rest with the House’s Energy and Commerce subcommittee on Health. Due to competing priorities and other legislative initiatives, passage of any relief legislation hinges on the need for our congressmen to acknowledge the impact to beneficiary access and industry businesses. The best thing you can do is to make sure they receive as many calls as possible to advocate escalation of the relief bill with a viable pay-for outside of DME. One such initiative that we have been advocating is the use of RAC payment reform as a vehicle to provide a meaningful reprieve to DME reimbursement cuts. The President included this in his 2017 budget proposal to fund appeals initiatives; however, continuation of DME services is a much better use of the funding.
Act now. Please make your voice heard! Let Congress know how important these issues are. If you’re unsure of who to contact, look up your senators here and your representatives here.