Could Rural Patients Lose Access to Durable Medical Equipment?

Dozens of legislators from the House of Representatives back a bill to stall cuts to Medicare reimbursement that could impair rural patient access to wheelchairs, oxygen, and other durable medical equipment.

Legislators in the House of Representatives have banded together to introduce a bill that would delay Medicare reimbursement cuts, in order to give rural patients continued access to the wheelchairs, oxygen, and walkers that they need. The bill, "Patient Access to Durable Medical Equipment of 2016" (the PADME Act, H.R. 5210) follows the introduction of legislation of the same name introduced in the Senate in March.

The PADME Act addresses the competitive bidding program that began a six-month phase-in period across the country, including rural areas, on January 1, 2016. The program brings with it reimbursement cuts that will be fully implemented on July 1, 2016. The concern is that some of these cuts could have a bigger negative impact on Medicare patients in rural areas because DME suppliers in these regions might need to decrease equipment inventory, cut staff, and deliver and train to fewer patients in a smaller geographic area to offset the reimbursement cuts.

"For many rural providers, these new rates will not even cover the cost of delivery for the item," a press release from bill co-sponsor Cathy McMorris Rodgers (R-WA) stated.

The bill, sponsored by Representatives Tom Price, MD (R-GA) and Dave Loebsack (D-IA), would extend the phase-in period, delaying the rate cut to October 1, 2017. In addition, the bid ceiling would not be less than the fiscal year 2015 fee schedule rate and CMS would be required to put out monthly reports on the program's impacts on Medicare beneficiary access to DME and health outcomes. The act would also require CMS to consider certain factors when determining rates, like travel distance, delivery time, number of suppliers, and volume of items and services

In March, a bill of the same name was introduced in the Senate by Senators John Thune (R-SD) and Heidi Heitkamp (D-ND) and co-sponsored by several others. The House legislation uses much of the same language as the Senate bill, S. 2736, which was referred to the Senate Finance Committee.

In a statement regarding the House legislation, AdvaMed president and CEO Scott Whitaker explained, “For this expansion, CMS is using payment information based on bidding that did not take place in non-competitive bidding areas—many of which are rural in nature—where costs of providing products to Medicare beneficiaries may be very different and not representative of costs in existing competitively bid areas. These beneficiaries already face challenges to accessing DME, and with a potential cut in reimbursement for some medical technologies of more than 50 percent, there will be serious hardships for both Medicare patients and DME providers . . . AdvaMed has long maintained that CMS’s competitive bidding program has advanced without rigorous evaluation or a clear understanding of its impact on beneficiaries’ access to the products they require."

Senator Heitkamp said in a release, “For seniors throughout the country, including in rural areas like North Dakota, access to critical medical equipment like hospital beds, walkers, and oxygen supplies shouldn’t be a question. All seniors should be able to live with dignity and the support they need."