Should the Feds Continue to Subsidize Durable Medical Equipment? (H.R. 5210)

What is H.R. 5210?

(Updated July 18, 2017)

This bill would temporarily extend federal reimbursements for patients buying durable medical equipment (DME), which include things like wheelchairs, oxygen tanks, crutches, blood sugar monitors, and more. Currently, federal funding for patients buying DME is being severely cut and replaced with a bidding system where the companies providing DME bid on equipment against other healthcare providers.

The bill would delay further funding cuts for the federal reimbursements, preserving the current price of DME, where half the price of DME is determined by bidding and half the price is reimbursed by the government. This delay in cuts would stay in place until October 2017.

The bill would do three other things while funding cuts are on hold:

• Set a ceiling for the bidding system for each piece of DME at the maximum price of that DME in 2015, and then adjust the ceiling with inflation;

• Require the Centers for Medicare & Medicaid Services (CMS) to publish monthly reports about the effects of funding cuts on DME access for patients;

• Require the CMS to adjust the bidding rates to account for patients in rural and nonurban areas.

Argument in favor

The bill ensures that patients who need specific medical equipment to survive would be able to continue to afford their equipment while continuing to phase in a bidding system.

Argument opposed

There’s no legitimate reason to delay the implementation of a bidding system for DME providers, which will decrease overall prices even after federal reimbursements is cut.

Impact

Patients who use DME; people organizing auctions for DME; companies providing DME to patients; the CMS.

Cost of H.R. 5210

A CBO cost estimate is unavailable.

Additional Info

In Depth: Sponsoring Rep. Tom Price (R-GA) explained in a press release that the bill is critical because:

“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.”

Of Note: In situations where the bidding process doesn’t apply, Medicare covers the majority of the cost for patients buying DME. According to the Medicare website, patients only have to pay 20% of the equipment cost, and the full list of equipment covered includes:

“Air-fluidized beds and other support surfaces (these supplies are only rented); Blood sugar monitors; Blood sugar (glucose) test strips; Canes (however, white canes for the blind aren't covered); Commode chairs Continuous passive motion (CPM) machine; Crutches; Hospital beds; Infusion pumps and supplies (when necessary to administer certain drugs); Manual wheelchairs and power mobility devices; Nebulizers and nebulizer medications; Oxygen equipment and accessories; Patient lifts Sleep apnea and Continuous Positive Airway Pressure (CPAP) devices and accessories; Suction pumps; Traction equipment; and Walkers.

This bill has a companion in the Senate, which was introduced two months before this one. As of June 21, 2016, the companion bill has passed the Senate, so only the House and the President stand in the way of the bill becoming law.

Media:

• Sponsoring Rep. Tom Price (R-GA) Press Release
• Medicare Website
• HomeCare Magazine