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This Election is Over. Now What?

This was an interesting election year, was it not?

Senate

34 of the 100 seats in the Senate were up for grabs.

U.S. Senate Partisan Breakdown before and after the 2016 Election from Ballotpedia.
U.S. Senate Partisan Breakdown before and after the 2016 Election from Ballotpedia.

House

All 435 seats in the House of Representatives were in play for the election. (Musical chairs, anyone?)

U.S. House Partisan Breakdown before and after the 2016 Election
U.S. House Partisan Breakdown before and after the 2016 Election

 

Regardless of your political affiliation, the nail biter evening brought surprises for many. Now that it’s over and the new Administration and Congress are vowing to bring sweeping changes to healthcare, you might be asking how those changes might impact you.

Affordable Care Act

If you are one of the millions who have benefited from the Affordable Care Act, nothing will change for 2017. Enrollment for the 2017 coverage year will continue and according to many, you will not lose your healthcare coverage you’ve purchased on the Exchange for 2017.

What does that mean to you right now?

Enroll if you need healthcare coverage right now. You have until December 15 to make your application and payment to be covered starting January 1, 2017. Use the information that Dr. Edmund Pezalla provided to DPAC Insiders on his Ask An Expert presentation about Commercial Health Plans for people with diabetes. If you have questions regarding what would be covered under a particular plan, contact a local broker and get the answers or call the plans directly.

What does that mean to you in the future?

Great question. DPAC will be monitoring this issue closely, as we expect action to be taken by the 115th Congress immediately after inauguration. In fact, according to Kellyanne Conway, President-Elect Trump’s campaign manager, he is contemplating holding a “special session” of Congress to immediately repeal ACA.

While it’s unlikely that there will be an immediate impact to the U.S. public, this issue will intensify and polarize Congress over the next several months.

While DPAC recognizes that the Affordable Care Act has flaws, a full repeal without a reasonable solution puts millions of Americans at risk.

You can sign up for DPAC’s Insider Emails to get updates on the ACA issue. 

All Those Bills for Diabetes? Not Going Anywhere.

A special thanks to our community, which includes advocates from JDRF, ADA, AADE, and AACE. We believe that by working together, we get more done. And this Congress, we definitely saw that.

While we saw unprecedented support for the CGM Medicare Act of 2015 and the National Diabetes Clinical Care Commission Act in this Congress, the expectation is that neither bill will be brought to a House vote. (Hope springs eternal, but this lame duck session isn’t looking too springy.)

What does that mean to you right now?

We shouldn’t give up. There are still a few days that Congress will meet and have the opportunity to pass legislation, so there’s no better time than right now to send a message about these two bills.

Here. Click these images and send a message… right now.

CGM Medicare Access Act of 2015

 

National Diabetes Clinical Care Commission Act

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What does that mean to you in the future?

New Congress and new opportunities. Many of those who have already co-sponsored will return for the 115th Congress, and we will be pushing them to co-sponsor these bills when they are reintroduced.

This, of course, will also require our community to educate the newer members of Congress. DPAC and other organizations have several ways to do that, so stay tuned. Once January rolls around, we’ll be on it.

Now What?

Our community is passionate, intelligent, and committed. The incoming legislators may not quite understand what diabetes is (and what it isn’t), but they do understand numbers – budgetary numbers and the number of constituents who contact them to make diabetes a priority for policy.

Roll up your sleeves, DPAC Insiders. We have work to do.

Riddle Me This, Batman…

Why the Competitive Bidding Program is FLAWED.

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Riddle me this, Batman…

If I’m a Durable Medical Equipment supplier and I want to bid on the diabetes testing supplies mail-order market, should I be allowed to do so if there are allegations that I violated the federal False Claims Act by using a fictitious entity to make unsolicited telephone calls to Medicare beneficiaries in order to sell them durable medical equipment?

Short answer:

Yep.

What?

On July 1, 2016, ten durable medical equipment suppliers were awarded two-year contracts for diabetes testing supplies, because they were willing to accept a reimbursement rate of $8.32 for a box of 50 test strips. One of them was U.S. Healthcare Supply, LLC. as shown on the list of approved suppliers today. 

Except…. on September 7, 2016, the Department of Justice issued this statement.

Diabetic Medical Equipment Companies to Pay More Than $12 Million to Resolve False Claims Act Allegations

U.S. Healthcare Supply LLC and Oxford Diabetic Supply Inc. and the two owners and presidents of those companies have agreed to pay the United States more than $12.2 million to resolve allegations that they violated the federal False Claims Act by using a fictitious entity to make unsolicited telephone calls to Medicare beneficiaries in order to sell them durable medical equipment, the U.S. Department of Justice announced.  U.S. Healthcare Supply LLC, based in Milford, New Jersey, has agreed to pay more than $5 million, and Jon P. Letko, its owner and president, has agreed to pay more than $1 million.  His brother, Edward J. Letko, the owner and president of Oxford Diabetic Supply Inc., a medical equipment supplier that allegedly also participated in the scheme, has agreed to pay $6 million plus interest.

The companies cold-called Medicare beneficiaries and sold them diabetes supplies – violating the non-solicitation policy set by the government.

Still Listed?

We called U.S. Healthcare Supply, because they are STILL LISTED ON MEDICARE.GOV as an approved diabetes testing supplies provider. The poor representative stumbled over the answer, saying that they were no longer offering supplies for diabetes.

Riddle me this, Batman…. if the Department of Justice says they can’t sell, why is U.S. Healthcare Supply LLC still up on Medicare. gov? Let’s be real… it doesn’t take much to remove a link on the Internet. What else could be wrong with the Competitive Bidding Program? What other misinformation is being given to the public?

Someone put up a Bat Signal…

Wait.

We have one. 

 

Learn more about why the Competitive Bidding Program for diabetes testing supplies can’t continue and act now. 

How Bidding Has Failed

Suspend Medicare’s Competitive Bidding Program (CBP) For Diabetes Testing Supplies

What is the Medicare Competitive Bidding Program?

The Centers for Medicare and Medicaid Services (CMS) launched the Competitive Bidding Program (CBP) in 2011 with the goal of reducing out-of-pocket expenses for Medicare beneficiaries and provide cost-savings to Medicare for certain durable medical equipment, including blood glucose meters and strips, while still ensuring beneficiary access to quality items and services.

Why isn’t CBP working?

While a good idea in theory, serious issues have surfaced in reality with the implementation of the CBP. In 2012, the Government Accountability Office reported that monitoring methods used by CMS in assessing the impact of competitive bidding were insufficient. This year, a peer-reviewed article in the American Diabetes Association’s journal, Diabetes Care, shows the program for diabetes testing supplies has led to increased mortality, hospitalizations and costs among people with diabetes.

  • Deaths were nearly twice as high in the pilot markets studied compared with the rest of the Medicare population.
  • In test markets, Medicare beneficiaries experienced more than twice as many inpatient hospital admissions and more than double the associated costs.

The Diabetes Care article points to a variety of factors – including reduced reimbursement for testing supplies and requiring beneficiaries to switch from one supplier to another – that have led to a disruption of access to diabetes testing supplies.

Ultimately, the CBP has failed to reach its primary endpoint: Medicare is not saving money but it is causing confusion and costing lives.

What can we do about it?

ACT NOW to ask Congress toimmediately suspended The CMS Competitive Bidding Program. In human clinical trials, investigators have an ethical obligation to monitor the safety of study participants and terminate the study immediately whenever risk to patients is detected. CMS should be held to the same safety monitoring and standards as other clinical trials.

What makes matters worse is that this July, many Medicare beneficiaries will again experience this Screen Shot 2016-03-18 at 9.27.06 AMdisruption during an updated rollout of the program (Round 2 recompete).

Background: The Diabetes Care article is the result of a four-year, retrospective longitudinal study that compares the impact of competitive bidding in the nine test markets in which the Competitive Bidding Program was initially deployed with the rest of the nation. Test sites included Charlotte-Gastonia-Concord (NC and SC); Cincinnati-Middle-town (OH, KY and IN); Cleveland-Elyria-Mentor (OH); Dallas-Fort Worth-Arlington (TX); Kansas City (MO and KS); Miami-Fort Lauder-
dale-Pompano Beach (FL); Orlando (FL); Pittsburgh (PA); and Riverside-San Bernardino-Ontario (CA).
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