Federal and State Legislative Update John Gallagher - The VGM Group Jay Witter - AAHomecare 2020 2020 ~ The GOOD • HR 8158 BUDGET NEUTRALITY ACT • NIV Removed from Competitive Bidding Program • 3 Months Delay in Sequestration 2% ROUND 2021 COMPETITIVE BIDDING WINS • On October 27, the program was substantially altered to allow only “off –the-shelf” orthotic braces to be bid, with the remaining product categories removed. CMS proposed several payment options for these items in rural, non-rural and competitive bid areas, a matter of critical concern to our members. 2020 ~ The GOOD Federal Impact in the HME Community • $138 million back to HME providers through suspension of 2% sequestration cut with more to come following a recent three-month extension of the pause. • Share of the $88 billion CARES Act relief payments during the pandemic by ensuring HME providers were included among eligible health care categories. • 32% rate increase for non-bid, non-rural areas (75/25 blend) and extending 50/50 blend for rural areas through duration of COVID-19 PHE. • Significant regulatory waivers and flexibilities on respiratory care, proof of delivery, and authorization for Medicaid beneficiaries; many of these policy changes have also been adopted by Medicaid programs, MCOs, and other major payers, as well. • Passage of legislation to fix outdated budget neutrality provisions that had been severely impacting rural oxygen Medicare reimbursements – the culmination of a multi-year grassroots advocacy effort by HME stakeholders spearheaded by AAHomecare and VGM. 2020 ~ The GOOD • Telehealth Waivers • Thune Bill • Provider Relief Fund • Paycheck Protection Program (PPP) • Covid-19 Economic Injury Disaster Loans (EIDL) 2020 ~ THE BAD • Three Month Delay to 2% Sequestration ~ Need extended Relief • CMS proposed several payment options for these items in rural, non-rural and competitive bid areas, a matter of critical concern to our members. 2020 ~ The Ugly 2021 ~ THE CALM BEFORE THE STORM…. Primary Areas of Focus of 2021 • Federal Legislation • State Efforts • State Association • Regulatory • Research Key Legislative Issues for 2021 1. DME rule 2. Additional relief in CB and Non-CB areas 3. Additional sequestration relief 4. Make telehealth waivers permanent 5. Make CRT manual accessories relief permanent Federal ~ Build Industry Congressional Relationships 117th Congress • Freshmen members- Implement plan to meet/greet with congressional members along with state leaders and members • Prioritize and identify key committee assignments (Senate/House) • Identify membership/state Congressional Connections (GAP project) • Set up meetings with Problem Solvers Caucus/Rural and Underserved subcommittee (Ways & Means) and other related caucus’s • The White House/Administration (HHS/CMS) • Focus on Additional Relief in Competitive Bidding (CB) and Non-Rural Areas • Focus on Additional Sequestration Relief • Make Telehealth Waivers Permanent • Make CRT Manual Accessories Relief Permanent State Efforts • Strengthen existing state associations • State Licensure • Tax Exemption • Payer Relations and Reimbursements (MCO/state Medicaid) State Associations • Continue to keep State Association Calendar updated as industry focus • Update State Licensure Activity • Provide State Association Virtual Conferences to create Education and Revenue Opportunities • Identify membership/state Government Accountability Project (GAP project) • Create/Expand on Tool Kits helpful to State Associations - Expand on current state licensure tool kits - Legislative and Advocacy tool kits - Presidential/Board member tool kits - Membership Drive Regulatory • Monitor Proposed & New Rulemaking • Collaborate with CMS Ombudswoman • Set up Meeting in Baltimore to re-establish efforts with CMS Supplier Standards and Compliance Medical Review, documentation and claims audits Out of Business Supplier Analysis OPOLE • Round 2023 Preparation We will be offering continuing assistance once Bidding Program is announced. Once the proposed is final we will offer webinars or sessions as to the new payment schemes and offer examples and projections. Survey & Predictive Analytics Subcontracting Tools Contract Access Options Research, Studies, Projects * Facilitating reputable and useable studies GAO Study with Sen. Grassley • MCO Study • Reimbursement/RCM benchmarking survey • Competitive Bid Survey • Cost Shift Study • Update Leitten ROI study • Update Delivery Cost Study (regionally) • Benchmarking survey * Post Acute DME Cost Study Update Dr. Brown Study DME supplier numbers critical access hospitals 2021 ~ 117th Congressional Calendar Build Relationships with Senate Key Senate Players Chuck Grassley (R-IA) Joni Ernst (R-IA) John Thune (R-SD) Steve Daines (R-MT) Joe Manchin (D-WV) Vice Chairwoman Senate Finance Senate Finance Comm. Senate Finance Senate Approps Senate Rep. Conference GOP Whip Ron Wyden (D-OR) Tammy Duckworth (D-IL) Thomas R. Carper (D-DE) Sheldon Whitehouse Maggie Hassan (D-NH) Elizabeth Warren (D-MA) Patty Murray (D-WA) Senate Finance Small Business Senate Finance (D-RI) Senate Finance Senate HELP Chair - Senate HELP Chair Senate Judiciary Build Relationships with Senate/House House Ways and Means and House Energy and Commerce Democratic Members Republican Members: Democratic Members Republican Members: Kevin Brady, Ranking Member (R-TX) Richard E. Neal, Chair (D- •Frank Pallone, New Jersey, Chair •Cathy McMorris Rodgers, Devin Nunes (R-CA) •Bobby Rush, Illinois MA) Washington, Ranking Member Vern Buchanan (R-FL) •Anna Eshoo, California •Fred Upton, Michigan Lloyd Doggett (D-TX) Adrian Smith (R-NE) •Diana DeGette, Colorado •Michael C. Burgess, Texas Mike Thompson (D-CA) Kenny Marchant (R-TX) •Mike Doyle, Pennsylvania •Steve Scalise, Louisiana John B. Larson (D-CT) Tom Reed (R-NY) •Jan Schakowsky, Illinois •Bob Latta, Ohio Earl Blumenauer (D-OR) •G. K. Butterfield, North Carolina •Brett Guthrie, Kentucky Mike Kelly (R-PA) •Doris Matsui, California Ron Kind (D-WI) •David McKinley, West Virginia George Holding (R-NC) •Kathy Castor, Florida •Adam Kinzinger, Illinois Bill Pascrell, Jr. (D-NJ) Jason Smith (R-MO) •John Sarbanes, Maryland •Morgan Griffith, Virginia Danny K. Davis (D-IL) Tom Rice (R-SC) •Jerry McNerney, California •Gus Bilirakis, Florida Linda T. Sánchez (D-CA) David Schweikert (R-AZ) •Peter Welch, Vermont •Bill Johnson, Ohio Brian Higgins (D-NY) •Paul Tonko, New York •Billy Long, Missouri Jackie Walorski (R-IN) •Yvette Clarke, New York Terri A. Sewell (D-AL) •Larry Bucshon, Indiana Darin LaHood (R-IL) •Kurt Schrader, Oregon •Markwayne Mullin, Oklahoma Suzan DelBene (D-WA) Brad Wenstrup (R-OH) •Tony Cárdenas, California •Richard Hudson, North Carolina Judy Chu (D-CA) Jodey Arrington (R-TX) •Raul Ruiz, California •Tim Walberg, Michigan Gwen Moore (D-WI) Drew Ferguson (R-GA) •Scott Peters, California •Buddy Carter, Georgia Dan Kildee (D-MI) •Debbie Dingell, Michigan •Jeff Duncan, South Carolina Ron Estes (R-KS) •Marc Veasey, Texas Brendan Boyle (D-PA) •Gary Palmer, Alabama •Ann McLane Kuster, New Hampshire •Neal Dunn, Florida Don Beyer (D-VA) •Robin Kelly, Illinois •John Curtis, Utah Dwight Evans (D-PA) •Nanette Barragán, California •Debbie Lesko, Arizona Brad Schneider (D-IL) •Donald McEachin, Virginia •Greg Pence, Indiana Tom Suozzi (D-NY) •Lisa Blunt Rochester, Delaware •Dan Crenshaw, Texas •Darren Soto, Florida Jimmy Panetta (D-CA) •John Joyce, Pennsylvania •Tom O'Halleran, Arizona •Kelly Armstrong, North Dakota Stephanie Murphy (D-FL) •Kathleen Rice, New York Jimmy Gomez (D-CA) •Angie Craig, Minnesota Steven Horsford (D-NV) •Kim Schrier, Washington Stacey E. Plaskett (D-VI) •Lori Trahan, Massachusetts •Lizzie Fletcher, Texas Lisa Blunt Rochester, Dan Crenshaw, (R-TX) Stacey Plaskett, Kelly Armstrong, Angie Craig, (D- John Joyce (R- Lizzie Fletcher John Curtis (R- (D-DE) Energy and Energy and (D-VI) Ways and (R-ND), Energy MN), Energy and PA), Energy and (D-TX), Energy UT), Energy and Commerce Commerce means and Commerce Commerce Commerce and Commerce Commerce John B. Larson (D-CT) Ways and Means Peter Welch, (D-VT) Lori Trahan, (D-MA) Richard E. Neal, Chair Ann McLane Kuster, (D-NH) Energy and Commerce Energy and (D-MA) Ways and Energy and Commerce Commerce Means TEXAS AVENGERS MA FRESHMEN IN CONGRESS Rep. Jake Auchincloss (D-MA) 4th District Delivery Cost Survey PPP Loan Forgiven Tax? Many small businesses that file their taxes as pass-through entities may now face state taxes on their forgiven PPP loans because of the way Massachusetts conforms to the federal tax code. The Paycheck Protection Program was designed to ensure small businesses facing COVID restrictions, shutdowns, and rollbacks would be granted federal funds to keep their businesses running and prevent widespread closures. Business owners were told that if they followed the specific funding uses (payroll, rent, utilities, etc.) that the loans would be forgiven in full, but that is not necessarily true in Massachusetts. It is important to note, businesses filing as corporations will not face state taxes. News release from NFIB in Maine AUGUSTA (Jan. 25, 2021) – Today the Committee on Appropriations & Financial Affairs heard testimony on whether Maine should conform its state tax code to match federal tax law when it comes to a small businesses that took Paycheck Protection Program loans. Congress opted not to tax the proceeds if employers spent the funds on payroll, rent, and utilities and recently passed a provision to allow deductions for PPP loan expenses. But the Mills administration testified today