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(Jonathan Blum)
To begin, and on a cheerier note….
It’s now or never.
INDUSTRY FOCUS• FIGHT AUDIT ~ Lack of Appeal Process -HR 5083- supports DME-HR 1250-HR 2329 Hospital Centric-S. 1012
• Dear Colleague Letter to the OIG- Review of Competitive Bidding
• Round 2 Re-Bid
• Competitive Bidding Proposed Rule Comment Period through Sept 2, 2014
• HR 1717 – Market Pricing Plan
• Beneficiary Awareness and Mobilization - PFQC Hotline – 800.404.8702• August Recess-schedule a meeting with your congressional
members
AUDIT ~ Lack of Appeal Process!Chief ALJ Details 460k Appeals Backlog, Suspension of
Hearings
A recently obtained memorandum from the Office of Medicare Hearings and Appeals (OMHA) Chief Administrative Law Judge Nancy Griswold to Medicare providers awaiting multiple Administrative Law Judge appeal hearings details the exponential growth in appeals to Medicare audits. The letter provides the most up-to-date appeals data that has been released by The Centers for Medicare and Medicaid Services (CMS) to date and includes some particularly damning statistics and statements about the appeals system.
Judge Griswold states that from 2010-2013, OMHA’s claims workload grew by 184%. In just two years, the backlog of appealed claims has risen from 92,000 to 460,000, causing OMHA to suspend the assignment of hearing dates effective July 15, 2013.Citing a lack of additional resources allocated to handle the dramatic increase in appeals volume, Griswold states that in January 2012, their office averaged 1,250 appeals a week, in December 2013, they averaged 15,000. Average wait time now exceeds 16 months and with the current backlog, OMHA does not expect to begin assigning new ALJ hearing dates for at least 24 months. As a point of reference, there are a total of 65 Administrative Law Judges nationwide.
How can this be possible? How can CMS audit claims, require providers to respond and in most cases repay the disputed monetary value associated with the claim without offering an adequate appeals process? The lack of due process is truly appalling.
VGM's Audit Team's efforts result in 70 percent overturn of claims
re-submitted following the OMHA forum
Peggy Walker had her hands full of claims VGM had received from members who felt they were inappropriately denied by C2C Solutions. Peggy addressed the panel about the issue that day and followed up by sending the claims back to C2C Solutions for review.
In the HouseH.R. 5083- Audit Improvement and Reform (AIR) ActSponsor- Rep Ellmers, Renee [NC-2]-5 CosponsorsH.R. 1250 – Medicare Audit Improvement Act of 2013Sponsor – Rep Graves, Sam [MO-6] – 226 CosponsorsH.R. 2329 – Administrative Relief and Accurate Medicare Payments Act of 2013Sponsor – Rep Smith, Adrian [NE-3] – 20 Cosponsors
In SenateS. 1012 Medicare Audit Improvement Act of 2013Sponsor- Sen Blunt, Roy [MO]- 14 Cosponsors
LEGISLATIVE REMEDIES Suspend the CMS audit programs immediately to resume only when an effective timely appeal
channel is available to all providers. Stop recoupments on current claim denials that are waiting an ALJ hearing. Refund recoupments that have already occurred if appeal was made after July 15, 2013; during
the suspension of the appeal process. Prioritize medical necessity over technical issues that trigger denials in the first and second
levels. Support reform legislation to require fairness in audit programs including a fast and effective
independent appeal program that both protects the Medicare program, beneficiaries and medical equipment providers.
H.R. 1250, H.R. 2329 and the Senate bill S. 1012 address the issue for hospitals. But the current bill language doesn’t address Durable Medical Equipment (DME) Providers.
There is an urgent need to both support these bills and add DME to the language to protect vital homecare.
Introducing H.R. 5083H.R.5083Latest Title: Medicare Audit Improvement and Reform (AIR) ActSponsor: Rep Ellmers, Renee L. [NC-2] (introduced 7/11/2014) Cosponsors (4)Latest Major Action:7/11/2014 Referred to House committee. Status: Referred to the Committee on Energy and Commerce, and in addition to the Committee on Ways and Means, for a period to be subsequently determined by the Speaker, in each case for consideration of such provisions as fall within the jurisdiction of the committee concerned. · DMEPOS suppliers will receive a score on their error rates. Suppliers with low errors rates will receive fewer audits.
· DMEPOS suppliers with error rates of 15 percent or lower will only be subject to one random audit for the year they have a low error rate.
· Clinical inference is restored in the audit process.
· Look-back periods are limited to three years rather than five years for MACs and four years for RACs.
· MACs and RACs must provide quarterly training on avoiding frequent payment errors, including notice of all new audit procedures and education to avoid clerical errors.
H.R. 1250• H.R.1250
Latest Title: Medicare Audit Improvement Act of 2013 Sponsor: Rep Graves, Sam [MO-6] (introduced 3/19/2013) Cosponsors (226) Related Bills: S.1012 Latest Major Action: 3/22/2013 Referred to House subcommittee. Status: Referred to the Subcommittee on Health.
• 226 Co-sponsors• SUMMARY AS OF:
3/19/2013--Introduced.
• Medicare Audit Improvement Act of 2013 - Directs the Secretary of Health and Human Services (HHS) to establish a process which subjects to a single, combined maximum annual limit, applied incrementally, the number of additional documentation requests made to a hospital by Medicare administrative contractors, recovery audit contractors, or Comprehensive Error Rate Testing (CERT) program contractors pursuant to prepayment and postpayment audits requiring a hospital to submit a medical record for audit purposes.
• Directs the Secretary also to establish a distinct additional documentation request limit, computed according to a specified formula, for each hospital claim type for each hospital for a 45-day period in a year.
• Amends title XVIII (Medicare) of the Social Security Act with respect to the Medicare Integrity Program and use of recovery audit contractors.
• Requires the Secretary to ensure that recovery audit contracts include certain mandatory terms and conditions pertaining to: (1) penalties for certain compliance failures, (2) penalties for overturned appeals, (3) postpayment and prepayment audits, and (4) guidelines for prepayment review.
H.R. 2329• 20 Co-Sponsors• H.R.2329
Latest Title: Administrative Relief and Accurate Medicare Payments Act of 2013 Sponsor: Rep Smith, Adrian [NE-3] (introduced 6/12/2013) Cosponsors (20) Latest Major Action: 6/14/2013 Referred to House subcommittee. Status: Referred to the Subcommittee on Health.
• SUMMARY AS OF: 6/12/2013--Introduced.
• Administrative Relief and Accurate Medicare Payments Act of 2013 - Amends title XVIII (Medicare) of the Social Security Act to establish a maximum period of: (1) 2 years for submission of Medicare part B (Supplementary Medical Insurance) claims originally submitted by hospitals as Medicare part A (Hospital Insurance) claims, and (2) 60 days for certain such submissions for one-day stays.
• Reduces from 4 to 3 fiscal years the maximum look-back period under the Medicare Integrity Program for the audit and recovery activities of recovery audit contractors.
S.1012• S.1012
Latest Title: Medicare Audit Improvement Act of 2013 Sponsor: Sen Blunt, Roy [MO] (introduced 5/22/2013) Cosponsors (14) Related Bills: H.R.1250 Latest Major Action: 5/22/2013 Referred to Senate committee. Status: Read twice and referred to the Committee on Finance.
• 14 Co-Sponsors• SUMMARY AS OF:
5/22/2013--Introduced.• Medicare Audit Improvement Act of 2013 - Directs the Secretary of Health and Human Services (HHS) to establish a process which
subjects to a single, combined maximum annual limit, applied incrementally, the number of additional documentation requests made to a hospital by Medicare administrative contractors, recovery audit contractors, or Comprehensive Error Rate Testing (CERT) program contractors pursuant to prepayment and postpayment audits requiring a hospital to submit a medical record for audit purposes.
• Directs the Secretary also to establish a distinct additional documentation request limit, computed according to a specified formula, for each hospital claim type for each hospital for a 45-day period in a year.
• Amends title XVIII (Medicare) of the Social Security Act with respect to the Medicare Integrity Program and use of recovery audit contractors.
VGM Talking Points/Remedies
• Suspend CMS audit programs immediately to resume only when an effective and timely appeal channel is again available to all providers.
• Stop recoupments on current claim denials that are awaiting an ALJ hearing.
• Refund recoupments that have already occurred if appeal was made after July 15, 2013; during suspension of appeal process.
• Prioritize medical necessity over technical issues that trigger denials at the first and second levels.
• Support reform legislation to require fairness in audit programs including a fast and effective independent appeal program that both protects the Medicare program and medical providers
“Dear Colleague” Letter to OIG Daniel Levinson• Orchestrated by Rep. Tom Price (R-GA), Bruce Braley (D-IA), Tom
Reed (R-NY), and Tammy Duckworth (D-IL)
• Asking OIG to conduct a study of the impact of competitive bidding prior to the national rollout in 2016
117 signers as of 7/17/14
Competitive Bidding Round 2 Recompete Begins:• On July 15 CMS announced its plans to “recompete” (re-bid)
the supplier contracts awarded in Round 2 which currently encompasses 91 metropolitan areas.
• Current Round 2 product categories, the associated HCPC single payment amounts and geographic coverage areas remain in effect until June 30, 2016.
• While the CMS “pre-bidding supplier awareness program” begins now, the bidder registration period will be sometime this fall. Look for the associated CMS publication of item “bid limits” (which are the highest dollar amount a bidder can input per item on the bidding form) historical HCPC unit demand and beneficiary count, financial submission information, etc., also this fall.
• The actual 60-day “bid window” will likely be in early 2015.
• Most importantly – HME providers must be aware that the “bid limits” for all Round 2 recompete items will revert back to the Medicare Fee Schedule, plus an upward adjustment for inflation.
In simpler terms, the upper bidding amount will not “start at” the current reimbursement (single payment amount) in effect now for a Round 2 CBA. By way of example, one month’s rental of E1390 oxygen concentrator in Atlanta and Birmingham is currently reimbursed at $95.74. The recompete bid limit for this item will be $178.24 (plus any inflation adjustment) and NOT $95.74. Unless mitigated by legislation, CMS is required by law to recompete these contracts at least once every three years. At every “competition” the bid limit will revert to the Medicare Fee Schedule. This is an important issue, and VGM will expend considerable effort to ensure all bidding entities are aware of this fact.
Round 2 Recompete: New Product CategoriesCMS is conducting the Round 2 Recompete with seven product categories that differ from Round 2, but somewhat mirror (see exceptions below) the Round 1 recompete categories.
The Round 2 Recompete includes these categories of items and services:
• Enteral Nutrients, Equipment and Supplies• General Home Equipment and Related Supplies and Accessories (includes
hospital beds and related accessories, group 1 and 2 support surfaces, commode chairs, patient lifts, and seat lifts)
• Nebulizers and Related Supplies• Negative Pressure Wound Therapy (NPWT) Pumps and Related Supplies and
Accessories• Respiratory Equipment and Related Supplies and Accessories (includes
oxygen, oxygen equipment, and supplies; continuous positive airway pressure (CPAP) devices and respiratory assist devices (RADs) and related supplies and accessories)
• Standard Mobility Equipment and Related Accessories (includes walkers, standard power and manual wheelchairs, scooters, and related accessories)
• Transcutaneous Electrical Nerve Stimulation (TENS) Devices and Supplies
Changes from the Round 1 Recompete:• The external infusion pumps and supplies product category, which was bid in the
Round 1 Recompete, is not included in the Round 2 Recompete.• The general home equipment category removes transcutaneous electrical nerve
stimulation (TENS) devices.• The nebulizers and related supplies are now separate category (as compared to the
Round 1 respiratory equipment category which included these products).
Round 2 recompete bidders will note that the new categories include are broader, often combining what had been separate categories under Round 2. For example, CMS adopted a General Home Equipment and Related Supplies and Accessories product category, which includes hospital beds, support surfaces, commode chairs, patient lifts, and seat lifts. And, a Respiratory Equipment and Related Supplies and Accessories product category has been added, which includes both oxygen and CPAP/RAD devices. For some bidding entities, these product categories combine products not typically furnished by the supplier in the today’s marketplace. For example, HMEs furnishing oxygen and oxygen equipment do not necessarily furnish CPAP devices and RADs. (VGM will offer assistance and consulting with regard to this issue if applicable.)
The complete Round 2 recompete HCPCS Codes may be found here: http://dmecompetitivebid.com/palmetto/cbicrd2recompete.nsf/DocsCat/Product%20Categories
Round 2 Recompete: Same Geographic Coverage but New Bidding Areas (CBAs)
Metropolitan statistical areas (MSAs) are areas designated by the Office of Management and Budget (OMB) that include major cities and the suburban areas surrounding them. As a result of the OMB’s updates to the original 91 Round 2 MSAs , there are now 90 MSAs for the Round 2 Recompete. However, CMS is conducting the Round 2 Recompete in the same geographic areas that were included in Round 2.
Changes from Round 2• As a result of the February 2013 OMB update to the United
States MSAs, there are now 90 MSAs for the Round 2 Recompete. (The Poughkeepsie-Newburgh-Middletown, NY MSA is now consolidated into the New York-Northern New Jersey Long Island, NY-NJ-PA MSA. The Poughkeepsie-Newburgh-Middletown, NY CBA is now one of seven CBAs in the New York-Northern New Jersey-Long Island, NY-NJ-PA MSA)
• Most Round 2 Recompete MSAs have one CBA. However, the three largest MSAs (Chicago, Los Angeles, and New York) are subdivided into multiple CBAs, and CBAs in multi-state MSAs have been defined so that there are no multi-state CBAs. There are 117 CBAs in the Round 2 Recompete.
Example: Washington-Arlington-Alexandria, DC-VA-MD-WVCurrent CBA
Round 2 Recompete CBANow Arlington-Alexandria-Reston
Atlanta – Sandy Springs – Marietta, GA(no change)
CPAPTotal Suppliers 39Average Distance (miles) 443.84Less than 50 miles 14Out of state 23
Manual Power ChairTotal Suppliers 28Average Distance (miles) 297.09Less than 50 miles 10Out of state 14
OxygenTotal Suppliers 42Average Distance (miles) 318.3Less than 50 miles 18Out of state 16
Hospital BedsTotal Suppliers 28Average Distance (miles) 247.9Less than 50 miles 11Out of state 12
ENESTotal Suppliers 34Average Distance (miles) 479.9Less than 50 miles 11Out of state 20
Mail Order DiabeticTotal Suppliers 23Average Distance (miles) n/aLess than 50 miles n/a
Out of state n/a
NPWTPTotal Suppliers 24
Average Distance (miles) 401.3Less than 50 miles 8Out of state 9
Support SurfacesTotal Suppliers 22
Average Distance (miles) 219.78Less than 50 miles 7Out of state 9
WalkersTotal Suppliers 27
Average Distance (miles) 267.58Less than 50 miles 9Out of state 13
CPAPTotal Suppliers 29Average Distance (miles) 430.23Less than 50 miles 4Out of state 16
Manual Power ChairTotal Suppliers 22Average Distance (miles) 343.73Less than 50 miles 4Out of state 12
OxygenTotal Suppliers 33Average Distance (miles) 342.88Less than 50 miles 13Out of state 12
Hospital BedsTotal Suppliers 22Average Distance (miles) 234.85Less than 50 miles 7Out of state 8
ENESTotal Suppliers 27Average Distance (miles) 500.04Less than 50 miles 5Out of state 15
Mail Order DiabeticTotal Suppliers 23Average Distance (miles) n/aLess than 50 miles n/aOut of state n/a
NPWTPTotal Suppliers 13Average Distance (miles) 535.29Less than 50 miles 6Out of state 7
Support SurfacesTotal Suppliers 16Average Distance (miles) 359.88Less than 50 miles 4Out of state 7
WalkersTotal Suppliers 22Average Distance (miles) 230.72Less than 50 miles 6Out of state 8
CPAPTotal Suppliers 24Average Distance (miles) 386Less than 50 miles 5Out of state 14
Manual Power Chair Total Suppliers 14Average Distance (miles) 400.07Less than 50 miles 4Out of state 10
Oxygen Total Suppliers 24Average Distance (miles) 229.88Less than 50 miles 10Out of state 8
Hospital Beds Total Suppliers 15Average Distance (miles) 290.41Less than 50 miles 6Out of state 8
ENES Total Suppliers 21Average Distance (miles) 310.32Less than 50 miles 4Out of state 10
Mail Order DiabeticTotal Suppliers 23Average Distance (miles) n/aLess than 50 miles n/aOut of state n/a
NPWTP Total Suppliers 7Average Distance (miles) 266.16Less than 50 miles 2Out of state 4
Support Surfaces Total Suppliers 13Average Distance (miles) 524.96Less than 50 miles 4Out of state 9
Walkers Total Suppliers 16Average Distance (miles) 288.31Less than 50 miles 6Out of state 9
• CMS is also conducting the national mail-order recompete for diabetic testing supplies at the same time as the Round 2 Recompete.
• The national mail-order recompete includes all parts of the United States, including the 50 states, the District of Columbia, Puerto Rico, the U.S. Virgin Islands, Guam, and American Samoa.
Round 2 Recompete: TimelineJuly 15, 2014• CMS began pre-bidding supplier awareness program
Fall 2014 • CMS announces bidding schedule• CMS begins bidder education program• Bidder registration period to obtain user ID and passwords begins
Winter 2015• Bidding Begins• VGM will again offer Round 2 Recompete Bidding Education
and Consultation! Look for details shortly via this Legislative Update, on my front page blog http://www.vgm.com/, and through your state associations.
More information to come. Mark and John “Road show”
coming soon.
The Mark and John road Show
CMS-1614-P• The Affordable Care Act amended the
Medicare Modernization Act statute to mandate use of information from the DMEPOS competitive bidding program to adjust the fee schedule amounts for DME in areas where competitive bidding programs are not implemented by no later than January 1, 2016.
• CMS estimates that by applying bid rates throughout the entire United States it would save over $7 billion over FY 2016 through 2020.
DME Provisions…• Proposed (changes to) the
methodology for making national price adjustments based upon information gathered from (all previous) competitive bidding program (CBPs).
• Proposed phase in of special payment rules in a limited number of areas (12) under the CBP for certain DME and enteral nutrition.
• Update the definition of minimal self-adjustment of orthotics.
• Change of Ownership Rules to Allow Contract Suppliers to Sell Specific Lines of Business
“National” Pricing• How? Adjust fee schedule amounts for
states in different regions of the country based on previous competitive bidding round pricing in these “regions”.
• The regional prices would be limited by a national ceiling (110% of the average of regional prices) and floor (90% of the average of regional prices)
• “Regions” are yet to be finalized…
• CMS determines a regional price for each state equal to the un-weighted average of the single payment amount for an item or service from the CBAs that are fully or partially located in the same region where the state is located.
• CMS determines a national average price equal to the average of the regional prices.
• The regional price cannot be greater than 110 percent of the national average nor less than 90 percent of the national average price.
• Adjust fee schedules annually using CPI-U
• Revise the SPA each time there is a new round of bidding.
• Use national ceiling for rural states and outside contiguous US.
“Bundling”…• This is a limited phase in (12 areas)
of bundled monthly payment amounts for the equipment, supplies, accessories, maintenance and repairs for enteral nutrition, oxygen, standard wheelchairs, hospital beds, CPAP/RAD in place of capped rental policies.
• Bidding would start sometime after 1/1/2015.
• The SPA is based on bids submitted and accepted on a monthly basis for each month of medical need during the contract period.
• Monthly single payment amount would include payment for all nutrients, supplies and equipment.
• Payment is made on a continuous monthly rental basis for DME. The SPA Includes rent, maintenance and service, and replacement of supplies and accessories necessary.
• No separate payments for M&S
• Deadline for comments is Sept. 2, 2014
Senator Hoeven Letter to TavennerSigned on…
Hoeven (R-ND)
Thune (R-SD)
Casey (D-PA)
Sen. Hoeven (R-ND)Sen. Heitkamp (D-NDSen. Thune (R-SD)Sen. Tim Johnson (D-SD)Sen. Casey (D-PA)Sen. Toomey (R-PA)Sen. Bennet (D-CO)Sen. Udall (D-CO)Sen. Grassley (R-IA)Sen. Schatz (D-HI)Sen. Hirono (D-HI)Sen. Enzi (R-WY)Sen. Barrasso (R-WY)Sen. Vitter (R-LA)Sen. Alexander (R-TN)Sen. Corker (R-TN)Sen. Coats (R-IN)Sen. Donnelly (D-IN)Sen. Blunt (R-MO)Sen. Moran (R-KS)Sen. Roberts (R-KS)Sen. Chambliss (R-GA)Sen. Isakson (R-GA)Sen. Cochran (R-MS)Sen. Wicker (R-MS)Sen. Manchin (D-WV)Sen. Inhofe (R-OK)Sen. Johanns (R-NE)Sen. Fischer (R-NE)Sen. Rubio (R-FL)Sen. Crapo (R-ID)Sen. Scott (R-SC)Sen. Portman (R-OH)Sen. Baldwin (D-WI)Sen. Cardin (D-MD)Sen King (I-ME)Sen. Burr (R-NC)Sen. Ayotte (R-NH)Sen. Shelby (R-AL)
UPDATE: MARKET BASED PRICIING PROGRAM (MPP)
Rep Barletta, Lou [PA-11] Rep Long, Billy [MO-7] Rep Maffei, Daniel [NY-24] Rep McCarthy, Carolyn [NY-4]
Rep Blackburn, Marsha [TN-7] Rep Coffman, Mike [CO.-6] Rep Boustany, Charles W. Jr. [LA-3] Rep Visclosky, Peter [IN-1]
Rep Braley, Bruce L. [IA-1] Rep Wittman, Robert J. [VA-1] Rep. Rahall, Nick [WV-3] Rep Rush, Bobby [IL-1]
Rep Capito, Shelley Moore [WV-2] Rep Buchanan, Vern [FL-16] Rep Tipton, Scott [CO-3] Rep Bonner, Jo [AL-1]
Rep Chabot, Steve [OH-1] Rep Westmoreland, Lynn A. [GA-3] Rep Hanna, Richard [NY-22] Rep Rooney, Thomas [FL-17]
Rep Crenshaw, Ander [FL-4] Rep McCaul, Michael T. [TX-10] Rep Rogers, Mike [AL-3] Rep Bishop, Timothy [NY-1]
Rep DesJarlais, Scott [TN-4] Rep Broun, Paul C. [GA-10] Rep Meadows, Mark [NC-11] Rep Coble, Howard [NC-6]
Rep Fortenberry, Jeff [NE-1] Rep Rokita, Todd [IN-4] Rep Bilirakis, Gus [FL-12] Rep Tsongas, Niki [MA-3]
Rep Grimm, Michael G. [NY-11] Rep Young, C. W. Bill [FL-13] Rep Langevin, James [RI-2] Rep Terry, Lee [NE-2]
Rep Harper, Gregg [MS-3] Rep King, Steve [IA-4] Rep Collins, Chris [NY-27] Rep Murphy, Tim [PA-18]
Rep Johnson, Bill [OH-6] Rep Barrow, John [GA12] Rep Turner, Michael [OH-10] Rep Rogers, Harold [KY-5]
Rep Joyce, David P. [OH-14] Rep Huizenga, Bill [MI-2] Rep Stivers, Steve [OH-15] Rep Gingrey, Phil [GA-11]
Rep King, Peter T. [NY-2] Rep Forbes, J. Randy [VA-4] Rep Kline, John [MN-2] Rep Matheson, Jim [UT-4]
Rep Lankford, James [OK-5] Rep Ruppersberger, C. A. Dutch [MD-2] Rep Rothfus, Keith [PA-12] Rep Miller, Jeff [FL-1]
Rep Larson, John B. [CT-1] Rep Latham, Tom [IA-3] Rep Cole, Tom [OK-4] Rep Massie, Thomas [KY-4]
Rep Loebsack, David [IA-2] Rep Gibbs, Bob [OH-7] Rep Fleischmann, Charles “Chuck” [TN-3] Rep Nugent, Richard [FL-11]
Rep Marino, Tom [PA-10] Rep Lance, Leonard [NJ-7] Rep Sensenbrenner, James Jr. [WI-5] Rep Duckworth, Tammy [IL-8]
Rep McKinley, David B. [WV-1] Rep Collins, Doug [GA-9] Rep Enyart, William [IL-12] Rep Griffin, Tim [Ar-2]
Rep Nunnelee, Alan [MS-1] Rep Brooks, Mo [AL-5] Rep Kelly, Mike [PA-3] Rep Michaud, Michael [ME-2]
Rep Posey, Bill [FL-8] Rep Nunes, Devin [CA-22] Rep Bentivolio, Kerry [MI-11] Rep Jordan, Jim [OH-4]
Rep Roe, David P. [TN-1] Rep Meehan, Patrick [PA-7] Rep Wilson, Joe [SC-2] Rep Ros-Lehtinen, Ileana [FL-27]
Rep Ryan, Tim [OH-13] Rep Smith, Christopher [NJ-4] Rep Ross, Dennis [FL-15] Rep Palazzo, Steven [MS-4]
Rep Scott, Austin [GA-8] Rep Rogres, Mike [MI-8] Rep Johnson, Henry “Hank” Jr [GA-4] Rep Keating, William [MA-9]
Rep Thompson, Glenn [PA-5] Rep Whitfield, Ed [KY-1] Rep Tiberi, Patrick J. [OH-12] Rep Olson, Pete [TX-22]
H.R. 1717
The Medicare DMEPOS Market Pricing Program Act of 2013
H.R. 4920Latest Title: Medicare DMEPOS Competitive Bidding Improvement Act of 2014 Sponsor: Rep Tiberi, Patrick J. [OH-12] (introduced 6/19/2014) Cosponsors (21) Latest Major Action: 6/19/2014 Referred to House committee. Status: Referred to the Committee on Energy and Commerce, and in addition to the Committee on Ways and Means, for a period to be subsequently determined by the Speaker, in each case for consideration of such provisions as fall within the jurisdiction of the committee concerned.
Medicare DMEPOS Competitive Bidding Improvement Act of 2014 - Amends title XVIII (Medicare) of the Social Security Act to require state licensure and a bid and surety bond of at least $50,000 for each area for bidding entities under the Medicare durable medical equipment, prosthetics, orthotics, and supplies (DMEPOS) competitive acquisition program.
House AppropriationsHarold Rogers, Chair KY-05C.W. Bill Young FL-13
Frank R. Wolf VA-10Jack Kingston GA-01Rodney Frelinghuysen NJ-11
Tom Latham IA-03Robert B. Aderholt AL-04Kay Granger TX-12Mike Simpson ID-02John Culberson TX-07
Ander Crenshaw FL-04John Carter TX-31Rodney Alexander LA-05Ken Calvert CA-42Jo Bonner AL-01Tom Cole OK-04
Mario Diaz-Balart FL-25Charlie Dent PA-15
Sam Graves MO-06
Kevin Yoder KS-03Steve Womack AR-03Alan Nunnelee MS-01
Jeff Fortenberry NE-01
Tom Rooney FL-17Chuck Fleischmann TN-03Jaime Herrera Beutler WA-03David Joyce OH-14David G. Valadao CA-21
Nita M. Lowey, Ranking Member NY-17Marcy Kaptur OH-09Peter J Visclosky IN-01Jose E. Serrano NY-15Rosa DeLauro CT-03James P. Moran VA-08Ed Pastor AZ-07David E. Price NC-04Lucille Roybal-Allard CA-40Sam Farr CA-20Chaka Fattah PA-02
Sanford D. Bishop Jr. GA-02Barbara Lee CA-13Adam B Schiff CA-28Michael M. Honda CA-17
Betty McCollum MN-04Steve Israel NY-03Tim Ryan OH-13C.A. Dutch Ruppersberger MD-02
Debbie Wasserman Schultz FL-23Henry Cuellar TX-28Chellie Pingree ME-01
Republicans
Democrats
House Energy & CommerceFred Upton, Chair MI-06Ralph Hall TX-04Joe Barton TX-06Edward Whitfield KY-01John Shimkus IL-15Joe Pitts PA16Greg Walden OR-02Lee Terry NE-02Mike Rogers MI-08Tim Murphy PA-18Michael Burgess TX-26Marsha Blackburn TN-07Phil Gingrey GA-11Steve Scalise LA-01Bob Latta OH-05Cathy McMorris Rodgers WA-05Gregg Harper MS-03Leonard Lance NJ-07Bill Cassidy LA-06Brett Guthrie KY-02Pete Olson TX-22David B. McKinley WV-01Cory Gardner CO-04
Mike Pompeo KS-04Adam Kinzinger IL-16Morgan Griffith VA-09Gus Bilirakis FL-12Bill Johnson OH-06
Billy Long MO-07Renee Ellmers NC-02
Henry Waxman, Rnk. Member CA-33John Dingell MI-12Edward Markey MA-05Frank Pallone Jr. NJ-06Bobby Rush IL-01Anna Eshoo CA-18Eliot Engel NY-16Gene Green TX-29Diana DeGette CO-01Lois Capps CA-24Mike Doyle PA-14Jan Schakowsky IL-09Jim Matheson UT-04G.K. Butterfield NC-01John Barrow GA-12Doris Matsui CA-06Donna M.C. Christensen VI-AL
Kathy Castor FL-14John Sarbanes MD-03Jerry McNerney CA-09
Bruce Braley IA-01Peter Welch VT-ALBen Ray Lujan NM-03Paul Tonko NY-20
RepublicansDemocrats
House Ways & Means
Dave Camp, Chair MI-04Sam Johnson TX-03Kevin Brady TX-08Paul Ryan WI-01Devin Nunes CA-22Pat Tiberi OH-12Dave Reichert WA-08Charles Boustany Jr. LA-03Peter Roskam IL-06Jim Gerlach PA-06Tom Price GA-06Vern Buchanan FL-16Adrian Smith NE-03Aaron Schock IL-18Lynn Jenkins KS-02Erik Paulsen MN-03Kenny Marchant TX-24Diane Black TN-06Tom Reed NY-23Todd Young IN-09Mike Kelly PA-03Tim Griffin AR-02
Sander Levin, Rnk. Member MI-09Charles B. Rangel NY-13Jim McDermott WA-07John Lewis GA-05Richard Neal MA-01Xavier Becerra CA-34Lloyd Doggett TX-35Bennie Thompson MS-02John B. Larson CT-01Earl Blumenauer OR-03Ron Kind WI-03Bill Pascrell Jr. NJ-09Joseph Crowley NY-14Allyson Schwartz PA-13Danny K. Davis IL-07Linda T. Sanchez CA-38
Republicans Democrats
Senate Appropriations
Barbara Mikulski, Chair MD
Patrick Leahy VT
Tom Harkin IAPatty Murray WADianne Feinstein CA
Richard Durbin IL
Tim Johnson SDMary Landrieu LA
Jack Reed RIFrank Lautenberg NJMark Pryor ARJon Tester MTSherrod Brown OH
Thad Cochran, Rnk. Member MSMitch McConnell KYRichard Shelby ALLamar Alexander TN
Susan Collins MELisa Murkowski AKLindsey Graham SC
Mark Kirk IL
Dan Coats IN
Roy Blunt MO
Jerry Moran KS
John Hoeven NDRon Johnson WI
RepublicansDemocrats
= S.1012
Senate Finance
Ron Wyden, Chair ORJay Rockefeller WVCharles Shumer NYDebbie Stabenow MIMaria Cantwell WABill Nelson FLRobert Menendez NJThomas Carper DEBenjamin Cardin MDSherrod Brown OHMichael Bennet CORobert Casey, Jr. PA
Orrin Hatch, Rnk. Member UTCharles Grassley IAMichael Crapo IDPat Roberts KSMichael Enzi WYJohn Cornyn TXJohn Thune SDRichard Burr NCJohnny Isakson GARob Portman OHPatrick Tommey PA
Democrats Republicans
= S.1012
Senate Health Education Labor Pensions (H.E.L.P.)
Democrats Republicans
Tom Harkin, Chair IABarbara Mikulski MDPatty Murray WABernard Sanders VTBob Casey PAKay Hagan NCJeff Merkley ORAl Franken MNMichael Bennet COSheldon Whitehouse RIRichard Blumenthal CT
Michael Enzi, Rnk. Member WYLamar Alexandar TNRichard Burr NCJohnny Isakson GARand Paul KYOrrin Hatch UTJohn McCain AZPat Roberts KSLisa Murkowski AKMark Kirk IL
= S.1012
ACTION STEPS
• Educate new members of Congress about flaws of CB and the need to replace with MPP!
• Contact Congressional Members who signed on to H.R. 6490 and let them know that H.R. 1717 was introduced ~ ASK that they contact Reps. Tom Price (R-GA) or John Larson (D-CT) to cosign.
http://www.youtube.com/peopleforqualitycare
• Contact Congressional Members have not signed on to HR 5083, HR 1250 and HR 2329 and let them know this is their chance to right a wrong.
Go to the resource center VGM DC Link (www.vgmdclink.com) for handouts to use with your representatives.
202.224.3121
Use the VGM DC Link and use the editable letter available to e-mail your legislators directly via the site.
Summer Meetings
• Schedule Meetings with Key Congressional Members• In District• Conference Call
• Contact VGM for Meeting Materials
Rep. Tom Price Event
Norco/Cantor- Idaho
Norco/Wyden-Oregon
Sen. Heitkamp-North DakotaGreat Plains Rehab, ND- Rep. Cramer
Note: Beneficiaries can be transferred over to US Capitol Switchboard to talk to their Member of Congress’ Health LA to pass on their complaint.
GO TO:www.peopleforqualitycare.org/Resources/Personal-Stories
TO VIEW/SHARE STORIES OF BENEFICIARIES IMPACTED BY COMPETITIVE BIDDING
We need more beneficiaries to tell their story!
Over 3000
Complaints
Received!!
3236!!!
• Callers are patched directly to D.C.
• PFQC will follow-up weekly with callers to make sure they did make contact with their Legislator
• The hotline is there for beneficiaries, caregivers, health professionals, advocacy groups to voice concerns
• Dear Colleague Letter to the OIG- Review of Competitive Bidding
• FIGHT AUDIT ~ Lack of Appeal Process -HR 5083- supports DME-HR 1250-HR 2329 Hospital Centric-S. 1012
• Round 2 Re-Bid
• Competitive Bidding Proposed Rule Comment Period through Sept 2, 2014
• HR 1717 – Market Pricing Plan
• Beneficiary Awareness and Mobilization - PFQC Hotline – 800.404.8702
• August Recess-schedule a meeting with your congressional members
