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 House H.R. 5083- Audit Improvement and Reform (AIR) Act Sponsor- Rep Ellmers, Renee [NC-2]-5 Cosponsors H.R. 1250 – Medicare Audit Improvement Act of 2013 Sponsor – Rep Graves, Sam [MO-6] – 226 CosponsorsRep Graves, Sam H.R. 2329 – Administrative Relief and Accurate Medicare Payments Act of 2013 Sponsor – Rep Smith, Adrian [NE-3] – 20 CosponsorsRep Smith, Adrian In Senate S. 1012 Medicare Audit Improvement Act of 2013 Sponsor- Sen Blunt, Roy [MO]- 14 Cosponsors 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. 5083 H.R.5083 Latest Title: Medicare Audit Improvement and Reform (AIR) Act Sponsor: 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.Cosponsors · 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.Rep Graves, SamCosponsorsS.1012 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.Rep Smith, AdrianCosponsors 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.Sen Blunt, RoyCosponsorsH.R.1250 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 “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 Categories CMS 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 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-WV Current CBA Round 2 Recompete CBA Now Arlington-Alexandria-Reston
Atlanta – Sandy Springs – Marietta, GA (no change) CPAP Total Suppliers 39 Average Distance (miles) 443.84 Less than 50 miles 14 Out of state 23 Manual Power Chair Total Suppliers 28 Average Distance (miles) 297.09 Less than 50 miles 10 Out of state 14 Oxygen Total Suppliers 42 Average Distance (miles) 318.3 Less than 50 miles 18 Out of state 16 Hospital Beds Total Suppliers 28 Average Distance (miles) 247.9 Less than 50 miles 11 Out of state 12 ENES Total Suppliers 34 Average Distance (miles) 479.9 Less than 50 miles 11 Out of state 20 Mail Order Diabetic Total Suppliers23 Average Distance (miles)n/a Less than 50 milesn/a Out of staten/a NPWTP Total Suppliers24 Average Distance (miles) 401.3 Less than 50 miles8 Out of state9 Support Surfaces Total Suppliers22 Average Distance (miles) 219.78 Less than 50 miles7 Out of state9 Walkers Total Suppliers27 Average Distance (miles) 267.58 Less than 50 miles9 Out of state13
CPAP Total Suppliers 29 Average Distance (miles) 430.23 Less than 50 miles 4 Out of state 16 Manual Power Chair Total Suppliers 22 Average Distance (miles) 343.73 Less than 50 miles 4 Out of state 12 Oxygen Total Suppliers 33 Average Distance (miles) 342.88 Less than 50 miles 13 Out of state 12 Hospital Beds Total Suppliers 22 Average Distance (miles) 234.85 Less than 50 miles 7 Out of state 8 ENES Total Suppliers 27 Average Distance (miles) 500.04 Less than 50 miles 5 Out of state 15 Mail Order Diabetic Total Suppliers23 Average Distance (miles)n/a Less than 50 milesn/a Out of staten/a NPWTP Total Suppliers13 Average Distance (miles) 535.29 Less than 50 miles6 Out of state7 Support Surfaces Total Suppliers16 Average Distance (miles) 359.88 Less than 50 miles4 Out of state7 Walkers Total Suppliers22 Average Distance (miles) 230.72 Less than 50 miles6 Out of state8
CPAP Total Suppliers 24 Average Distance (miles) 386 Less than 50 miles 5 Out of state 14 Manual Power Chair Total Suppliers 14 Average Distance (miles) 400.07 Less than 50 miles 4 Out of state 10 Oxygen Total Suppliers 24 Average Distance (miles) 229.88 Less than 50 miles 10 Out of state 8 Hospital Beds Total Suppliers 15 Average Distance (miles) 290.41 Less than 50 miles 6 Out of state 8 ENES Total Suppliers 21 Average Distance (miles) 310.32 Less than 50 miles 4 Out of state 10 Mail Order Diabetic Total Suppliers23 Average Distance (miles)n/a Less than 50 milesn/a Out of staten/a NPWTP Total Suppliers7 Average Distance (miles) 266.16 Less than 50 miles2 Out of state4 Support Surfaces Total Suppliers13 Average Distance (miles) 524.96 Less than 50 miles4 Out of state9 Walkers Total Suppliers16 Average Distance (miles) 288.31 Less than 50 miles6 Out of state9
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: Timeline July 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.http://www.vgm.com/
More information to come. Mark and John “Road show” coming soon. 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 Deadline for comments is Sept. 2, 2014
Senator Hoeven Letter to Tavenner Signed on… Hoeven (R-ND) Thune (R-SD) Casey (D-PA) Sen. Hoeven (R-ND) Sen. Heitkamp (D-ND Sen. 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 )
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. 4920 Latest 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.Rep Tiberi, Patrick J.Cosponsors 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 Appropriations Harold Rogers, ChairKY-05 C.W. Bill YoungFL-13 Frank R. WolfVA-10 Jack Kingston GA-01 Rodney FrelinghuysenNJ-11 Tom LathamIA-03 Robert B. Aderholt AL-04 Kay GrangerTX-12 Mike SimpsonID-02 John CulbersonTX-07 Ander CrenshawFL-04 John CarterTX-31 Rodney AlexanderLA-05 Ken CalvertCA-42 Jo Bonner AL-01 Tom ColeOK-04 Mario Diaz-BalartFL-25 Charlie DentPA-15 Sam GravesMO-06 Kevin YoderKS-03 Steve WomackAR-03 Alan NunneleeMS-01 Jeff FortenberryNE-01 Tom RooneyFL-17 Chuck FleischmannTN-03 Jaime Herrera BeutlerWA-03 David JoyceOH-14 David G. ValadaoCA-21 Nita M. Lowey, Ranking MemberNY-17 Marcy KapturOH-09 Peter J ViscloskyIN-01 Jose E. SerranoNY-15 Rosa DeLauroCT-03 James P. MoranVA-08 Ed PastorAZ-07 David E. PriceNC-04 Lucille Roybal-AllardCA-40 Sam FarrCA-20 Chaka FattahPA-02 Sanford D. Bishop Jr. GA-02 Barbara LeeCA-13 Adam B SchiffCA-28 Michael M. HondaCA-17 Betty McCollumMN-04 Steve IsraelNY-03 Tim RyanOH-13 C.A. Dutch RuppersbergerMD-02 Debbie Wasserman SchultzFL-23 Henry CuellarTX-28 Chellie PingreeME-01RepublicansDemocrats
House Energy & Commerce Fred Upton, ChairMI-06 Ralph HallTX-04 Joe BartonTX-06 Edward WhitfieldKY-01 John ShimkusIL-15 Joe PittsPA16 Greg WaldenOR-02 Lee TerryNE-02 Mike RogersMI-08 Tim MurphyPA-18 Michael BurgessTX-26 Marsha BlackburnTN-07 Phil Gingrey GA-11 Steve ScaliseLA-01 Bob LattaOH-05 Cathy McMorris RodgersWA-05 Gregg HarperMS-03 Leonard LanceNJ-07 Bill CassidyLA-06 Brett GuthrieKY-02 Pete OlsonTX-22 David B. McKinleyWV-01 Cory GardnerCO-04 Mike PompeoKS-04 Adam KinzingerIL-16 Morgan GriffithVA-09 Gus BilirakisFL-12 Bill JohnsonOH-06 Billy LongMO-07 Renee EllmersNC-02 Henry Waxman, Rnk. Member CA-33 John DingellMI-12 Edward MarkeyMA-05 Frank Pallone Jr.NJ-06 Bobby RushIL-01 Anna EshooCA-18 Eliot EngelNY-16 Gene GreenTX-29 Diana DeGetteCO-01 Lois CappsCA-24 Mike DoylePA-14 Jan SchakowskyIL-09 Jim MathesonUT-04 G.K. ButterfieldNC-01 John Barrow GA-12 Doris MatsuiCA-06 Donna M.C. ChristensenVI-AL Kathy CastorFL-14 John SarbanesMD-03 Jerry McNerneyCA-09 Bruce BraleyIA-01 Peter WelchVT-AL Ben Ray LujanNM-03 Paul TonkoNY-20 Republicans Democrats
House Ways & Means Dave Camp, ChairMI-04 Sam JohnsonTX-03 Kevin BradyTX-08 Paul RyanWI-01 Devin NunesCA-22 Pat TiberiOH-12 Dave ReichertWA-08 Charles Boustany Jr.LA-03 Peter RoskamIL-06 Jim GerlachPA-06 Tom PriceGA-06 Vern BuchananFL-16 Adrian SmithNE-03 Aaron SchockIL-18 Lynn JenkinsKS-02 Erik PaulsenMN-03 Kenny MarchantTX-24 Diane BlackTN-06 Tom ReedNY-23 Todd YoungIN-09 Mike KellyPA-03 Tim GriffinAR-02 Sander Levin, Rnk. MemberMI-09 Charles B. RangelNY-13 Jim McDermottWA-07 John Lewis GA-05 Richard NealMA-01 Xavier BecerraCA-34 Lloyd DoggettTX-35 Bennie ThompsonMS-02 John B. LarsonCT-01 Earl BlumenauerOR-03 Ron KindWI-03 Bill Pascrell Jr.NJ-09 Joseph CrowleyNY-14 Allyson SchwartzPA-13 Danny K. DavisIL-07 Linda T. SanchezCA-38 Republicans Democrats
Senate Appropriations Barbara Mikulski, ChairMD Patrick LeahyVT Tom HarkinIA Patty MurrayWA Dianne FeinsteinCA Richard DurbinIL Tim JohnsonSD Mary LandrieuLA Jack ReedRI Frank LautenbergNJ Mark PryorAR Jon TesterMT Sherrod BrownOH Thad Cochran, Rnk. MemberMS Mitch McConnellKY Richard ShelbyAL Lamar AlexanderTN Susan CollinsME Lisa MurkowskiAK Lindsey GrahamSC Mark KirkIL Dan CoatsIN Roy BluntMO Jerry MoranKS John HoevenND Ron JohnsonWI RepublicansDemocrats = S.1012
Senate Finance Senate Finance Ron Wyden, ChairOR Jay RockefellerWV Charles ShumerNY Debbie StabenowMI Maria CantwellWA Bill NelsonFL Robert MenendezNJ Thomas CarperDE Benjamin CardinMD Sherrod BrownOH Michael BennetCO Robert Casey, Jr.PA Orrin Hatch, Rnk. MemberUT Charles GrassleyIA Michael CrapoID Pat RobertsKS Michael EnziWY John CornynTX John ThuneSD Richard BurrNC Johnny Isakson GA Rob PortmanOH Patrick TommeyPA DemocratsRepublicans = S.1012
Senate Health Education Labor Pensions (H.E.L.P.) DemocratsRepublicans Tom Harkin, ChairIA Barbara MikulskiMD Patty MurrayWA Bernard SandersVT Bob CaseyPA Kay HaganNC Jeff MerkleyOR Al FrankenMN Michael BennetCO Sheldon WhitehouseRI Richard BlumenthalCT Michael Enzi, Rnk. MemberWY Lamar AlexandarTN Richard BurrNC Johnny Isakson GA Rand PaulKY Orrin HatchUT John McCainAZ Pat RobertsKS Lisa MurkowskiAK Mark KirkIL = S.1012
ACTION STEPS ACTION STEPS Educate new members of Congress about flaws of CB and the need to replace with MPP! Tom Price (R- GA) 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.
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 Dakota Great 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. Callers are patched directly to D.C. PFQC will follow-up weekly with callers to make sure they did make contact with their Legislator 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 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
Mark Higley VGM Group, Inc. firstname.lastname@example.org 319.504.9515 Emily Harken 866-512-8456
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