Home Health Care Industry One Step Closer to New Medicare Pricing System?

Representative Tom Price, M.D. (R-Ga.) has agreed to introduce a bill in the U.S. House of Representatives replacing the current Medicare competitive bidding program for durable medical equipment and prosthetics, orthotics, and supplies (DMEPOS) with a market pricing program (MPP), a move strongly supported by many home health care groups. 

The Centers for Medicare & Medicaid Services (CMS) has awarded 51% of bidding contracts to small providers (those with revenues of $3.5 million or less), but many of those smaller suppliers complain that the current system favors large companies, putting them at a competitive disadvantage.

H.R. 1041, “Fairness in Medicare Bidding Act,” recommends market-based pricing and was introduced and referred to the House Committees on Appropriations, Energy and Commerce, and Ways and Means in March 2011. Originally sponsored by Rep. Glenn Thompson (R-Pa.), the bill now has 172 cosponsors comprised of both Republicans and Democrats, but GovTrack.us gives it only a 5% chance of being enacted.

A Sept. 11 congressional hearing on the impact of Medicare’s DME competitive bidding program on small suppliers featured testimonies from stakeholders, including the president of Bridgeville, Pa.-based Advacare Home Services testifying on behalf of the American Association for Home Care. 

In her written testimony, Advacare president Tammy Zelenko highlighted “the flaws of the current competitive program” along with recommending a “sound, sustainable and budget-neutral alternative”—the MPP.

Rep. Price had agreed in August to introduce the bill for a market-based system to the House. 

Written by Alyssa Gerace

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