[Congressional Record Volume 162, Number 107 (Tuesday, July 5, 2016)]
[House]
[Pages H4230-H4235]
From the Congressional Record Online through the Government Publishing Office [www.gpo.gov]
PATIENT ACCESS TO DURABLE MEDICAL EQUIPMENT ACT OF 2016
Mr. PITTS. Mr. Speaker, I move to suspend the rules and pass the bill
(H.R. 5210) to improve access to durable medical equipment for Medicare
beneficiaries under the Medicare program, and for other purposes, as
amended.
The Clerk read the title of the bill.
The text of the bill is as follows:
H.R. 5210
Be it enacted by the Senate and House of Representatives of
the United States of America in Congress assembled,
SECTION 1. SHORT TITLE.
This Act may be cited as the ``Patient Access to Durable
Medical Equipment Act of 2016'' or the ``PADME Act''.
SEC. 2. INCREASING OVERSIGHT OF TERMINATION OF MEDICAID
PROVIDERS.
(a) Increased Oversight and Reporting.--
(1) State reporting requirements.--Section 1902(kk) of the
Social Security Act (42 U.S.C. 1396a(kk)) is amended--
(A) by redesignating paragraph (8) as paragraph (9); and
[[Page H4231]]
(B) by inserting after paragraph (7) the following new
paragraph:
``(8) Provider terminations.--
``(A) In general.--Beginning on July 1, 2018, in the case
of a notification under subsection (a)(41) with respect to a
termination for a reason specified in section 455.101 of
title 42, Code of Federal Regulations (as in effect on
November 1, 2015) or for any other reason specified by the
Secretary, of the participation of a provider of services or
any other person under the State plan (or under a waiver of
the plan), the State, not later than 21 business days after
the effective date of such termination, submits to the
Secretary with respect to any such provider or person, as
appropriate--
``(i) the name of such provider or person;
``(ii) the provider type of such provider or person;
``(iii) the specialty of such provider's or person's
practice;
``(iv) the date of birth, Social Security number, national
provider identifier, Federal taxpayer identification number,
and the State license or certification number of such
provider or person;
``(v) the reason for the termination;
``(vi) a copy of the notice of termination sent to the
provider or person;
``(vii) the date on which such termination is effective, as
specified in the notice; and
``(viii) any other information required by the Secretary.
``(B) Effective date defined.--For purposes of this
paragraph, the term `effective date' means, with respect to a
termination described in subparagraph (A), the later of--
``(i) the date on which such termination is effective, as
specified in the notice of such termination; or
``(ii) the date on which all appeal rights applicable to
such termination have been exhausted or the timeline for any
such appeal has expired.''.
(2) Contract requirement for managed care entities.--
Section 1932(d) of the Social Security Act (42 U.S.C. 1396u-
2(d)) is amended by adding at the end the following new
paragraph:
``(5) Contract requirement for managed care entities.--With
respect to any contract with a managed care entity under
section 1903(m) or 1905(t)(3) (as applicable), no later than
July 1, 2018, such contract shall include a provision that
providers of services or persons terminated (as described in
section 1902(kk)(8)) from participation under this title,
title XVIII, or title XXI be terminated from participating
under this title as a provider in any network of such entity
that serves individuals eligible to receive medical
assistance under this title.''.
(3) Termination notification database.--Section 1902 of the
Social Security Act (42 U.S.C. 1396a) is amended by adding at
the end the following new subsection:
``(ll) Termination Notification Database.--In the case of a
provider of services or any other person whose participation
under this title, title XVIII, or title XXI is terminated (as
described in subsection (kk)(8)), the Secretary shall, not
later than 21 business days after the date on which the
Secretary terminates such participation under title XVIII or
is notified of such termination under subsection (a)(41) (as
applicable), review such termination and, if the Secretary
determines appropriate, include such termination in any
database or similar system developed pursuant to section
6401(b)(2) of the Patient Protection and Affordable Care Act
(42 U.S.C. 1395cc note; Public Law 111-148).''.
(4) No federal funds for items and services furnished by
terminated providers.--Section 1903 of the Social Security
Act (42 U.S.C. 1396b) is amended--
(A) in subsection (i)(2)--
(i) in subparagraph (A), by striking the comma at the end
and inserting a semicolon;
(ii) in subparagraph (B), by striking ``or'' at the end;
and
(iii) by adding at the end the following new subparagraph:
``(D) beginning not later than July 1, 2018, under the plan
by any provider of services or person whose participation in
the State plan is terminated (as described in section
1902(kk)(8)) after the date that is 60 days after the date on
which such termination is included in the database or other
system under section 1902(ll); or''; and
(B) in subsection (m), by inserting after paragraph (2) the
following new paragraph:
``(3) No payment shall be made under this title to a State
with respect to expenditures incurred by the State for
payment for services provided by a managed care entity (as
defined under section 1932(a)(1)) under the State plan under
this title (or under a waiver of the plan) unless the State--
``(A) beginning on July 1, 2018, has a contract with such
entity that complies with the requirement specified in
section 1932(d)(5); and
``(B) beginning on January 1, 2018, complies with the
requirement specified in section 1932(d)(6)(A).''.
(5) Development of uniform terminology for reasons for
provider termination.--Not later than July 1, 2017, the
Secretary of Health and Human Services shall, in consultation
with the heads of State agencies administering State Medicaid
plans (or waivers of such plans), issue regulations
establishing uniform terminology to be used with respect to
specifying reasons under subparagraph (A)(v) of paragraph (8)
of section 1902(kk) of the Social Security Act (42 U.S.C.
1396a(kk)), as amended by paragraph (1), for the termination
(as described in such paragraph) of the participation of
certain providers in the Medicaid program under title XIX of
such Act or the Children's Health Insurance Program under
title XXI of such Act.
(6) Conforming amendment.--Section 1902(a)(41) of the
Social Security Act (42 U.S.C. 1396a(a)(41)) is amended by
striking ``provide that whenever'' and inserting ``provide,
in accordance with subsection (kk)(8) (as applicable), that
whenever''.
(b) Increasing Availability of Medicaid Provider
Information.--
(1) FFS provider enrollment.--Section 1902(a) of the Social
Security Act (42 U.S.C. 1396a(a)) is amended by inserting
after paragraph (77) the following new paragraph:
``(78) provide that, not later than January 1, 2017, in the
case of a State plan (or a waiver of the plan) that provides
medical assistance on a fee-for-service basis, the State
shall require each provider furnishing items and services to
individuals eligible to receive medical assistance under such
plan to enroll with the State agency and provide to the State
agency the provider's identifying information, including the
name, specialty, date of birth, Social Security number,
national provider identifier, Federal taxpayer identification
number, and the State license or certification number of the
provider;''.
(2) Managed care provider enrollment.--Section 1932(d) of
the Social Security Act (42 U.S.C. 1396u-2(d)), as amended by
subsection (a)(2), is amended by adding at the end the
following new paragraph:
``(6) Enrollment of participating providers.--
``(A) In general.--Beginning not later than January 1,
2018, a State shall require that, in order to participate as
a provider in the network of a managed care entity that
provides services to, or orders, prescribes, refers, or
certifies eligibility for services for, individuals who are
eligible for medical assistance under the State plan under
this title (or under a waiver of the plan) and who are
enrolled with the entity, the provider is enrolled with the
State agency administering the State plan under this title
(or waiver of the plan). Such enrollment shall include
providing to the State agency the provider's identifying
information, including the name, specialty, date of birth,
Social Security number, national provider identifier, Federal
taxpayer identification number, and the State license or
certification number of the provider.
``(B) Rule of construction.--Nothing in subparagraph (A)
shall be construed as requiring a provider described in such
subparagraph to provide services to individuals who are not
enrolled with a managed care entity under this title.''.
(c) Coordination With CHIP.--
(1) In general.--Section 2107(e)(1) of the Social Security
Act (42 U.S.C. 1397gg(e)(1)) is amended--
(A) by redesignating subparagraphs (B), (C), (D), (E), (F),
(G), (H), (I), (J), (K), (L), (M), (N), and (O) as
subparagraphs (D), (E), (F), (G), (H), (I), (J), (K), (M),
(N), (O), (P), (Q), and (R), respectively;
(B) by inserting after subparagraph (A) the following new
subparagraphs:
``(B) Section 1902(a)(39) (relating to termination of
participation of certain providers).
``(C) Section 1902(a)(78) (relating to enrollment of
providers participating in State plans providing medical
assistance on a fee-for-service basis).'';
(C) by inserting after subparagraph (K) (as redesignated by
subparagraph (A)) the following new subparagraph:
``(L) Section 1903(m)(3) (relating to limitation on payment
with respect to managed care).''; and
(D) in subparagraph (P) (as redesignated by subparagraph
(A)), by striking ``(a)(2)(C) and (h)'' and inserting
``(a)(2)(C) (relating to Indian enrollment), (d)(5) (relating
to contract requirement for managed care entities), (d)(6)
(relating to enrollment of providers participating with a
managed care entity), and (h) (relating to special rules with
respect to Indian enrollees, Indian health care providers,
and Indian managed care entities)''.
(2) Excluding from medicaid providers excluded from chip.--
Section 1902(a)(39) of the Social Security Act (42 U.S.C.
1396a(a)(39)) is amended by striking ``title XVIII or any
other State plan under this title'' and inserting ``title
XVIII, any other State plan under this title (or waiver of
the plan), or any State child health plan under title XXI (or
waiver of the plan)''.
(d) Rule of Construction.--Nothing in this section shall be
construed as changing or limiting the appeal rights of
providers or the process for appeals of States under the
Social Security Act.
(e) OIG Report.--Not later than March 31, 2020, the
Inspector General of the Department of Health and Human
Services shall submit to Congress a report on the
implementation of the amendments made by this section. Such
report shall include the following:
(1) An assessment of the extent to which providers who are
included under subsection (ll) of section 1902 of the Social
Security Act (42 U.S.C. 1396a) (as added by subsection
(a)(3)) in the database or similar system referred to in such
subsection are terminated (as described in subsection (kk)(8)
of such section, as added by subsection (a)(1)) from
participation in all State plans under title XIX of such Act
(or waivers of such plans).
(2) Information on the amount of Federal financial
participation paid to States under section 1903 of such Act
in violation of the
[[Page H4232]]
limitation on such payment specified in subsections (i)(2)(D)
and (m)(3) of such section, as added by subsection (a)(4) of
this section.
(3) An assessment of the extent to which contracts with
managed care entities under title XIX of such Act comply with
the requirement specified in section 1932(d)(5) of such Act,
as added by subsection (a)(2) of this section.
(4) An assessment of the extent to which providers have
been enrolled under section 1902(a)(78) or 1932(d)(6)(A) of
such Act (42 U.S.C. 1396a(a)(78), 1396u-2(d)(6)(A)) with
State agencies administering State plans under title XIX of
such Act (or waivers of such plans).
SEC. 3. REQUIRING PUBLICATION OF FEE-FOR-SERVICE PROVIDER
DIRECTORY.
(a) In General.--Section 1902(a) of the Social Security Act
(42 U.S.C. 1396a(a)) is amended--
(1) in paragraph (80), by striking ``and'' at the end;
(2) in paragraph (81), by striking the period at the end
and inserting ``; and''; and
(3) by inserting after paragraph (81) the following new
paragraph:
``(82) provide that, not later than January 1, 2017, in the
case of a State plan (or waiver of the plan) that provides
medical assistance on a fee-for-service basis or through a
primary care case-management system described in section
1915(b)(1) (other than a primary care case management entity
(as defined by the Secretary)), the State shall publish (and
update on at least an annual basis) on the public Website of
the State agency administering the State plan, a directory of
the physicians described in subsection (mm) and, at State
option, other providers described in such subsection that--
``(A) includes--
``(i) with respect to each such physician or provider--
``(I) the name of the physician or provider;
``(II) the specialty of the physician or provider;
``(III) the address at which the physician or provider
provides services; and
``(IV) the telephone number of the physician or provider;
and
``(ii) with respect to any such physician or provider
participating in such a primary care case-management system,
information regarding--
``(I) whether the physician or provider is accepting as new
patients individuals who receive medical assistance under
this title; and
``(II) the physician's or provider's cultural and
linguistic capabilities, including the languages spoken by
the physician or provider or by the skilled medical
interpreter providing interpretation services at the
physician's or provider's office; and
``(B) may include, at State option, with respect to each
such physician or provider--
``(i) the Internet website of such physician or provider;
or
``(ii) whether the physician or provider is accepting as
new patients individuals who receive medical assistance under
this title.''.
(b) Directory Physician or Provider Described.--Section
1902 of the Social Security Act (42 U.S.C. 1396a), as amended
by section 2(a)(3), is further amended by adding at the end
the following new subsection:
``(mm) Directory Physician or Provider Described.--A
physician or provider described in this subsection is--
``(1) in the case of a physician or provider of a provider
type for which the State agency, as a condition on receiving
payment for items and services furnished by the physician or
provider to individuals eligible to receive medical
assistance under the State plan, requires the enrollment of
the physician or provider with the State agency, a physician
or a provider that--
``(A) is enrolled with the agency as of the date on which
the directory is published or updated (as applicable) under
subsection (a)(82); and
``(B) received payment under the State plan in the 12-month
period preceding such date; and
``(2) in the case of a physician or provider of a provider
type for which the State agency does not require such
enrollment, a physician or provider that received payment
under the State plan (or waiver of the plan) in the 12-month
period preceding the date on which the directory is published
or updated (as applicable) under subsection (a)(82).''.
(c) Rule of Construction.--
(1) In general.--The amendment made by subsection (a) shall
not be construed to apply in the case of a State (as defined
for purposes of title XIX of the Social Security Act) in
which all the individuals enrolled in the State plan under
such title (or under a waiver of such plan), other than
individuals described in paragraph (2), are enrolled with a
medicaid managed care organization (as defined in section
1903(m)(1)(A) of such Act (42 U.S.C. 1396b(m)(1)(A))),
including prepaid inpatient health plans and prepaid
ambulatory health plans (as defined by the Secretary of
Health and Human Services).
(2) Individuals described.--An individual described in this
paragraph is an individual who is an Indian (as defined in
section 4 of the Indian Health Care Improvement Act (25
U.S.C. 1603)) or an Alaska Native.
(d) Exception for State Legislation.--In the case of a
State plan under title XIX of the Social Security Act (42
U.S.C. 1396 et seq.), which the Secretary of Health and Human
Services determines requires State legislation in order for
the respective plan to meet one or more additional
requirements imposed by amendments made by this section, the
respective plan shall not be regarded as failing to comply
with the requirements of such title solely on the basis of
its failure to meet such an additional requirement before the
first day of the first calendar quarter beginning after the
close of the first regular session of the State legislature
that begins after the date of enactment of this Act. For
purposes of the previous sentence, in the case of a State
that has a 2-year legislative session, each year of the
session shall be considered to be a separate regular session
of the State legislature.
SEC. 4. EXTENSION OF THE TRANSITION TO NEW PAYMENT RATES FOR
DURABLE MEDICAL EQUIPMENT UNDER THE MEDICARE
PROGRAM.
(a) In General.--The Secretary of Health and Human Services
shall extend the transition period described in clause (i) of
section 414.210(g)(9) of title 42, Code of Federal
Regulations, from June 30, 2016, to September 30, 2016 (with
the full implementation described in clause (ii) of such
section applying to items and services furnished with dates
of service on or after October 1, 2016).
(b) Study and Report.--
(1) Study.--
(A) In general.--The Secretary of Health and Human Services
shall conduct a study that examines the impact of applicable
payment adjustments upon--
(i) the number of suppliers of durable medical equipment
that, on a date that is not before January 1, 2016, and not
later than September 1, 2016, ceased to conduct business as
such suppliers; and
(ii) the availability of durable medical equipment, during
the period beginning on January 1, 2016, and ending on
September 1, 2016, to individuals entitled to benefits under
part A of title XVIII of the Social Security Act (42 U.S.C.
1395 et seq.) or enrolled under part B of such title.
(B) Definitions.--For purposes of this subsection, the
following definitions apply:
(i) Supplier; durable medical equipment.--The terms
``supplier'' and ``durable medical equipment'' have the
meanings given such terms by section 1861 of the Social
Security Act (42 U.S.C. 1395x).
(ii) Applicable payment adjustment.--The term ``applicable
payment adjustment'' means a payment adjustment described in
section 414.210(g) of title 42, Code of Federal Regulations,
that is phased in by paragraph (9)(i) of such section. For
purposes of the preceding sentence, a payment adjustment that
is phased in pursuant to the extension under subsection (a)
shall be considered a payment adjustment that is phased in by
such paragraph (9)(i).
(2) Report.--The Secretary of Health and Human Services
shall, not later than September 10, 2016, submit to the
Committees on Ways and Means and on Energy and Commerce of
the House of Representatives, and to the Committee on Finance
of the Senate, a report on the findings of the study
conducted under paragraph (1).
SEC. 5. EXCLUSION OF PAYMENTS FROM STATE EUGENICS
COMPENSATION PROGRAMS FROM CONSIDERATION IN
DETERMINING ELIGIBILITY FOR, OR THE AMOUNT OF,
FEDERAL PUBLIC BENEFITS.
(a) In General.--Notwithstanding any other provision of
law, payments made under a State eugenics compensation
program shall not be considered as income or resources in
determining eligibility for, or the amount of, any Federal
public benefit.
(b) Definitions.--For purposes of this section:
(1) Federal public benefit.--The term ``Federal public
benefit'' means--
(A) any grant, contract, loan, professional license, or
commercial license provided by an agency of the United States
or by appropriated funds of the United States; and
(B) any retirement, welfare, health, disability, public or
assisted housing, postsecondary education, food assistance,
unemployment benefit, or any other similar benefit for which
payments or assistance are provided to an individual,
household, or family eligibility unit by an agency of the
United States or by appropriated funds of the United States.
(2) State eugenics compensation program.--The term ``State
eugenics compensation program'' means a program established
by State law that is intended to compensate individuals who
were sterilized under the authority of the State.
SEC. 6. DEPOSIT OF SAVINGS INTO MEDICARE IMPROVEMENT FUND.
Section 1898(b)(1) of the Social Security Act (42 U.S.C.
1395iii(b)(1)) is amended by striking ``$0'' and inserting
``$3,000,000''.
The SPEAKER pro tempore. Pursuant to the rule, the gentleman from
Pennsylvania (Mr. Pitts) and the gentleman from Vermont (Mr. Welch)
each will control 20 minutes.
The Chair recognizes the gentleman from Pennsylvania.
General Leave
Mr. PITTS. Mr. Speaker, I ask unanimous consent that all Members may
have 5 legislative days in which to revise and extend their remarks and
insert extraneous materials in the Record on the bill, including an
exchange of letters between the Committee on Energy and Commerce and
the Committee on Ways and Means.
The SPEAKER pro tempore. Is there objection to the request of the
gentleman from Pennsylvania?
[[Page H4233]]
There was no objection.
Mr. PITTS. Mr. Speaker, I yield myself such time as I may consume.
Mr. Speaker, the bipartisan bill before us accomplishes several
important objectives. Since 2003, the durable medical equipment, DME,
competitive bidding program has required DME suppliers in certain
large, densely populated areas to compete for contracts to serve
Medicare beneficiaries in those areas. This market-based competition
has saved the Medicare program and beneficiaries billions of dollars in
saving and reduced cost sharing.
Since 2009, CMS has had the authority to expand the program to
additional areas, and in 2014 the agency published a final rule that
will expand competitive bidding to all areas of the country. Beginning
January 1, 2016, CMS began phasing in new regional reimbursement rates
for noncompetitive bid areas using a 50-50 blend of old and new rates.
Starting July 1, rates will be based on the new calculations.
To ensure we have a full appreciation of the impact of the phase-in,
the bill continues the 50-50 blend payment for an additional 3 months.
It also requires HHS to report to Congress on any access issues caused
by the blended rate before the full rate change can go into effect.
The bill also improves access to quality healthcare providers for
vulnerable Medicaid patients and includes legislation that recently
passed the House 406-0.
In this legislation, we again reiterate the House's support to
address two important issues that plague Medicaid beneficiaries: first,
State Medicaid programs too often suffer from waste, fraud, and abuse;
and, second, too many Medicaid patients may have a hard time finding a
doctor.
The bill would ensure healthcare providers terminated from Medicare
or one State's Medicaid program for reasons of fraud, integrity, or
quality are also terminated from other State Medicaid programs. The
Office of Inspector General at HHS has previously found that 12 percent
of terminated providers were participating in a State Medicaid program
after the same provider was terminated from another State Medicaid
program. It is critical that fraudulent providers are not allowed to
defraud taxpayers or harm patients across the board.
The bill also requires State Medicaid programs to provide
beneficiaries served under fee-for-service or primary care case
management programs an electronic directory of physicians participating
in the program. This important effort will address a critical challenge
of Medicaid patients in accessing certain types of care, such as
obtaining specialty care or dental care. Medicaid patients would now
have better information by simply applying requirements similar to
those in place for Medicaid-managed care plans to fee-for-service and/
or primary care case management programs.
Finally, the bill includes legislation by Mr. McHenry and Mr.
Butterfield that ensures that payments made under a State eugenics
compensation program cannot be considered as income in determining
eligibility for any Federal public benefit. Simply put, the bill
prevents any funds from such a compensation program to be counted as
income for purposes of receiving any Federal benefits.
According to the Congressional Budget Office, H.R. 5210, as amended,
would be completely offset over the budget window. We will provide more
time to understand the impact of DME payment changes on Medicare
beneficiaries. We will also enact commonsense reforms that help protect
Medicaid beneficiaries, improve access to care, and enact an important
clarification for those eligible for certain State compensation
programs.
I want to thank Ranking Member Pallone and his staff as well as the
Committee on Ways and Means for their work on this compromise, and I
urge my colleagues to support H.R. 5210, as amended.
Mr. Speaker, I reserve the balance of my time.
House of Representatives,
Committee on Ways and Means,
Washington, DC, June 21, 2016.
The Hon. Fred Upton,
Chairman, Committee on Energy and Commerce,
Washington, DC.
Dear Chairman Upton: I am writing concerning H.R. 5210, the
``Patient Access to Durable Medical Equipment Act of 2016,''
on which the Committee on Ways and Means was granted an
additional referral.
In order to allow H.R. 5210 to move expeditiously to the
House floor, I agree to waive formal consideration of this
bill. The Committee on Ways and Means takes this action with
our mutual understanding that by foregoing consideration on
H.R. 5210 at this time, we do not waive any jurisdiction over
subject matter contained in this or similar legislation, and
that our Committee will be appropriately consulted and
involved as this bill or similar legislation moves forward.
Our Committee also reserves the right to seek appointment of
an appropriate number of conferees to any House-Senate
conference involving this or similar legislation, and asks
that you support any such request.
I would appreciate your response to this letter confirming
this understanding, and would request that you include a copy
of this letter and your response in the Congressional Record
during the floor consideration of this bill. Thank you in
advance for your cooperation.
Sincerely,
Kevin Brady,
Chairman.
____
House of Representatives,
Committee on Energy and Commerce,
Washington, DC, June 21, 2016.
The Hon. Kevin Brady,
Chairman, Committee on Ways and Means,
Washington, DC.
Dear Chairman Brady: Thank you for your letter regarding
H.R. 5210, the ``Patient Access to Durable Medical Equipment
Act of 2016,'' on which the Committee on Ways and Means was
granted an additional referral.
I appreciate your agreeing to waive formal consideration of
H.R. 5210 in order to allow the bill to move expeditiously to
the House floor.
I agree that by foregoing consideration on H.R. 5210 at
this time, the Committee on Ways and Means does not waive any
jurisdiction over subject matter contained in this or similar
legislation, and that the Committee will be appropriately
consulted and involved as this bill or similar legislation
moves forward. I also agree that the Committee reserves the
right to seek appointment of an appropriate number of
conferees to any House-Senate conference involving this or
similar legislation, and I will support any such request.
Finally, I will include a copy of your letter and this
response in the Congressional Record during the floor
consideration of this bill.
Sincerely,
Fred Upton,
Chairman.
Mr. WELCH. Mr. Speaker, I yield myself such time as I may consume.
I thank my colleague, Mr. Pitts. It is a pleasure to be working with
him and with Mr. Pallone and Mr. Upton.
This legislation, as Mr. Pitts indicated, is going to give some
relief to communities, particularly rural communities, from the
imposition of changes in how charges are made in competitive bidding
processes that have a significant potential to make inaccessible
durable medical equipment.
I was a cosponsor, but the lead sponsor is here, Dr. Price, a good
colleague and a really good doctor. Dr. Price, Legislator Price, came
up with a pretty good bill that is going to help Georgia but also help
rural Vermont, so I appreciate that.
{time} 1745
The bottom line, the DME Competitive Bidding Program was created in
2003. It was aimed at a goal all of us have. It was trying to lower
spending on durable medical equipment. It was well-intended, but it has
had some serious consequences, especially for rural providers, like in
Vermont, and I am sure parts of Georgia and other rural parts of the
country.
By the way, when we do something, it can have a good intention, it
can even accomplish some of its goals, but I think it always makes
sense for us on both sides to step back after there is some history--
this went in in 2003--and take a look, kick the tires. What are some of
the improvements that we can make so that we get back to the original
intention and don't do harm that is unnecessary? And that is what the
Price legislation is doing.
In January 2016, the Competitive Bidding Program began its nationwide
rollout. That was under the new CMS guidelines. As a result, the rural
areas saw significant cuts. It really does jeopardize access to this
important equipment for beneficiaries.
The CMS continued its rollout in July with a second round of cuts. It
further slashed reimbursement rates for DME across rural America,
including Vermont.
In Vermont, we have an excellent equipment provider, Yankee Medical,
that is reasonable in its price and incredibly good in its service. It
will
[[Page H4234]]
bring equipment to people all across rural Vermont. That is such a
benefit for folks who can't get out of their homes.
The rural areas do have different challenges than urban areas. It is
much more challenging for stakeholders to absorb these cuts. For
instance, a small business in rural Vermont in a noncompetitively bid
area may not have a large amount of Medicare-related businesses and,
therefore, might not be able to afford the prices that a business in a
much larger populated area could offer.
So this legislation is going to put on hold for 3 months what these
prices will be. It is going to allow time for some adjustment and,
hopefully, for us to consider other positive reforms that will be
helpful to maintaining access to important healthcare equipment for
folks in rural Vermont and rural America.
The bill contains a couple of other provisions, one of which I will
speak about. My colleague on the Energy and Commerce Committee, Mr.
Bucshon, was the lead sponsor and I was his cosponsor. As a way to pay
for this--and that was cracking down on this Medicare fraud, where
there has been a failure administratively--when a provider is found to
be fraudulent in one district, that fraud is not then communicated to
all other districts or States, so that fraudulent provider tries to
just take their operation elsewhere. This is going to require that
notification and it is going to shut down that fraud much more quickly,
saving money, and then helping us to pay for this.
So this is practical legislation, the result of a compromise by the
chairman and ranking member of the Energy and Commerce Committee, Mr.
Pitts, and some of my colleagues. Mr. Loebsack of Iowa played a very,
very active role in this legislation. Of course, Dr. Price did as well.
Mr. Speaker, I yield back the balance of my time.
Mr. PITTS. Mr. Speaker, I yield 3 minutes to the gentleman from
Georgia (Mr. Price), the distinguished Budget Committee chairman.
Mr. TOM PRICE of Georgia. Mr. Speaker, I want to thank the gentleman
from Pennsylvania for his work on this and his interest and passion for
healthcare issues and the work that we do in this House. I also want to
thank the gentleman from Vermont for his kind words and the work he has
done on this; and the gentleman from Iowa as well, who has been
instrumental in moving this legislation forward.
Mr. Speaker, many Medicare beneficiaries rely on a set of healthcare
products and services that are classified as durable medical equipment,
or DME. DME is often life-improving or lifesaving; things like blood
sugar monitors, canes, crutches, hospital beds, power wheelchairs, and
even things like oxygen supplies and tanks. Without access to these
items, many Medicare beneficiaries would not be able to survive or
would see their quality of life greatly diminished.
In January 2016, Medicare started to slash reimbursement rates for
these products and services as part of a nationwide rollout of their
Competitive Bidding Program.
Mr. Speaker, I would suggest that this program is neither competitive
nor is it a real bidding process. CMS now wants to extend these
substandard rates and this substandard program to other areas, as you
have heard, including rural regions of our Nation, where these new
rates will oftentimes not even cover the cost of the delivery of the
item or the service, which means they just won't happen.
In addition, this CMS program has failed to hold bidders to account.
It has failed to produce rates that are financially sustainable for
those who are trying to provide these service and items to patients.
The National Minority Quality Forum has data that demonstrates this
program is driving up costs through avoidable hospital bills and
inpatient admissions, increasing out-of-pocket payments by patients,
and has led to increased mortality rates. Mr. Speaker, that is more
people dying in our Nation because of this program.
In just my home State of Georgia, there has been a 20 percent
decrease in the number of DME suppliers between 2013 and 2016. The
number of medical equipment supply stores in our State has similarly
decreased by nearly 40 percent.
The legislation we have before us today, H.R. 5210, would provide a
3-month delay in the cuts, hopefully allowing for work to be done to
come up with a real solution.
This legislation represents a bipartisan commitment to ensure that
Medicare beneficiaries continue receiving critical care provided
through durable medical equipment, particularly those living in the
rural areas of our Nation who would be disproportionately harmed by
cuts in reimbursements.
Again, this delay will, hopefully, provide policymakers additional
time to come up with a consensus on a long-term solution. Every effort
must be made to protect access to quality health care for seniors.
I want to thank, again, my colleagues on both sides of the aisle for
their work on this issue. I want to, once again, commend Chairman Pitts
for his work on this issue.
I urge adoption of the bill.
Mr. PITTS. Mr. Speaker, I urge support for this bipartisan bill, H.R.
5210.
I yield back the balance of my time.
Mr. PALLONE. Mr. Speaker, I cannot support a delay in the expansion
of the competitive bidding program. Competitive bidding for durable
medical equipment, prosthetics, orthotics, and supplies (DMEPOS) has
saved the Medicare program billions of dollars. And lowering costs for
the Medicare program means lower copayments for Medicare beneficiaries.
Over the years, it has been widely documented by the HHS Office of
Inspector General and the Government Accountability Office that
Medicare payments for DMEPOS far exceeded reasonable costs. This is why
Congress passed legislation requiring competitive bidding for DMEPOS
incrementally. Since 2011, CMS has closely monitored all beneficiaries
in the competitive bidding areas, and there have been no access
concerns. Health outcomes are steady compared to before Medicare began
the competitive bidding program. CMS will continue to monitor health
outcomes, and until we see any concerns, I do not believe we should
stop the progress in saving money for both beneficiaries and the
Medicare program.
That said, the Medicaid policies in this legislation were passed by
the House in March of this year, 406-0, after consideration by the
House Energy and Commerce Committee. The first policy, the Medicaid DOC
Act, is an initiative first introduced by Reps. Collins and Tonko and
would require states that participate in fee-for-service Medicaid to
publish electronic provider directories. It's important for patients to
know what providers participate in the Medicaid program. States are
required to provide electronic directories in managed care, but the
same requirement does not exist across the full Medicaid program. The
Committee worked throughout the legislative process to streamline this
policy with current federal provider directory regulations in Medicaid
managed care. The legislation details the minimum items that must be
included in a provider directory, but also allows states to go beyond
these standards.
The second policy is an initiative first introduced by Reps. Bucshon,
Welch, and Butterfield and would provide CMS with critical tools to
keep patients safe, protect taxpayer dollars, and protect the integrity
of the Medicaid program. The ACA included a provision that prohibited
disqualified providers from Medicare or one state Medicaid program from
simply crossing state lines and receiving payments in another state
Medicaid program. Unfortunately, as drafted, the law has been hard to
implement, because states don't have a consistent or standardized way
of knowing when a specific provider has been terminated by Medicare or
another state. States are not currently required to report this
information, and if it is reported, it is in many differing formats,
limiting the data's usability. This provision would require all states
to report information on fraudulent providers to the Secretary for
inclusion in a currently existing termination database that is
accessible to all states. The legislation also requires the Secretary
to develop uniform criteria for states to use when submitting
information. I supported both of these commonsense policies in the
past, and I continue to support them today.
Mr. McDERMOTT. Mr. Speaker, this bill, H.R. 5210, the Patient Access
to Durable Medical Equipment Act, delays the implementation of recent
changes to durable medical equipment payments.
For the past several years, Medicare has been reforming how we pay
for DME, including items like oxygen tanks, walkers, or hospital beds.
In much of the country, CMS uses competitive bidding to determine how
much DME costs. But in some communities, primarily in rural areas, CMS
pays under the DME fee
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schedule. Under this payment system, there is no competitive market to
drive prices down.
Nonpartisan, independent experts, including MedPAC and the
Government Accountability Office, have warned us that Medicare is
overpaying for DME through the fee schedule.
To address this problem, CMS has been phasing in new payments that
will reduce DME costs under the fee schedule based on competitive
bidding pricing. These lower payments are scheduled to be fully phased
in by July.
Getting DME costs under control is critical. Higher prices result in
increased Medicare spending and, even more importantly, they force
beneficiaries to pay more out of pocket.
At the same time, some DME suppliers and beneficiary groups have
expressed concerns that lowering the price for DME too far could hinder
beneficiary access to important equipment.
To address this issue, the bill before us provides a compromise that
will institute a temporary delay of the lower DME fee schedule payments
for three months. This pause will allow us to gather more data on how
the new payment rates impact beneficiary access.
That being said, it's not entirely clear that this delay is
necessary. CMS has already been carefully monitoring access to DME.
Just this month, the agency released data showing that payment cuts
have not caused any harm to suppliers or to beneficiaries.
Even as we have significantly reduced spending, suppliers continue to
accept the reformed payment rates, and there is no evidence that
beneficiary access to high quality DME has been hindered.
This bill will give us three more months to verify that this is the
case. This is only a short-term freeze, and if the evidence continues
to show that the new payment rates are working, there will be no reason
for us to delay any longer.
The SPEAKER pro tempore. The question is on the motion offered by the
gentleman from Pennsylvania (Mr. Pitts) that the House suspend the
rules and pass the bill, H.R. 5210, as amended.
The question was taken; and (two-thirds being in the affirmative) the
rules were suspended and the bill, as amended, was passed.
A motion to reconsider was laid on the table.
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