Floor Situation

On Tuesday, July 5, 2016, the House will consider H.R. 5210, Patient Access to Durable Medical Equipment (PADME) Act, as amended, under a suspension of the rules. H.R. 5210 was introduced on May 12, 2016 by Rep. Tom Price (R-GA) and was referred to the Energy and Commerce Committee, in addition to the Ways and Means Committee.

Bill Summary

H.R. 5210 would delay the implementation of new Medicaid payment rates for durable medical equipment (DME) for three months, until October 1, 2016. The Secretary of Health and Human Services would also be required to conduct a study examining the impact of DME payment adjustments.

Also included in the legislation is:

• H.R. 3716, the Ensuring Access to Quality Medicaid Providers Act (Bucshon, R-IN), which would require States and Medicaid managed care plans to report to the Secretary of Human Health and Services (HHS) identifying information for providers terminated for reasons related to fraud, integrity and quality from Medicare or the Medicaid or Children’s Health Insurance Program (CHIP). The bill would also require: providers participating in Medicaid or CHIP managed care to be enrolled with the State; CMS to include State reported provider terminations and Medicare provider terminations in its Termination Notification Database or equivalent system; and States to pay back the federal portion of Medicaid and CHIP payments made to terminated providers for services performed more than 60 days after a provider’s termination is included in the CMS Termination Notification Database. H.R. 3716 also contains the text of H.R. 3821, the Medicaid Directory of Caregivers Act (Collins, R-NY), which would which would require State Medicaid programs to provide beneficiaries served under fee-for-service (FFS) or primary care case management (PCCM) programs an electronic directory of physicians who have served Medicaid patients in the prior year.
• H.R. 2949, the Treatment of Certain Payments in Eugenics Compensation Act (McHenry, R-NC), which would exclude payments made under a state eugenics compensation program from classification as income or resources in determining eligibility for, or the amount of, any federal public benefit. The bill defines “state eugenics compensation program” as a state program for compensating individuals who were sterilized under the authority of the state.

Background

The Medicare Supplementary Medical Insurance Program (Part B) currently covers a wide variety of durable medical equipment, prosthetics, orthotics, and other medical supplies (DMEPOS) if they are medically necessary and are prescribed by a physician.[1] Examples of durable medical equipment (DME) includes: blood sugar monitors, canes, crutches, hospital beds, and wheelchairs.[2]

The Medicare Prescription Drug, Improvement and Modernization Act of 2003 (P.L. 108-173) required the Secretary of Health and Human Services to establish a competitive acquisition program, also known as competitive bidding) under which prices for selected DMEPOS sold in specified areas would be determined not by suppliers’ bids. The first payments based on the bids of winning suppliers went into effect in 2011 in only nine metropolitan areas. In the non-competitive bid areas, Medicare continued to pay for most DMEPOS on the basis of fee schedules.[3]

A nationwide rollout of the competitive bidding program began in January 2016, with the competitive bid reimbursement rates that went into effect on July 1 for previously non-competitive bid areas. This legislation would extend the transition period by three months until October 1^st because there are concerns that the reimbursement rates are too low and will result in a lack of patient access to DME. For example, in some rural areas, the payments may not even cover the cost of delivery.

According to the sponsor, “Every single day, many rely on durable medical equipment such as wheel chairs, oxygen tanks, and canes to maintain their health and wellbeing. This bipartisan effort seeks to allow providers of this equipment the ability to continue to supply lifesaving medical supplies to patients regardless of where they live.”[4]

H.R. 3716, which is included in this legislation, previously passed the House unanimously on March 2, 2016. See the Legislative Digest for more information.

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[1] See CRS Report, “Medicare Durable Medical Equipment: the Competitive Bidding Program,” July 22, 2013.
[2] See  Medicare.gov “Your Medicare Coverage”
[3] See CRS Report, “Medicare Durable Medical Equipment: the Competitive Bidding Program,” July 22, 2013.
[4] See Press Release, “Price Introduces Legislation with Bipartisan Support to Protect Patient Access to Durable Medical Equipment,”  May 12, 2016.

Cost

A Congressional Budget Office (CBO) estimate is currently unavailable, but CBO conducted a preliminary estimate that determined enacting H.R. 5210 would have no net effect on the deficit between the 2016-2026 period.

Additional Information

For questions or further information please contact Molly Newell with the House Republican Policy Committee by email or at 2-1374.