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    Congress cuts coverage for erection devices

    Funding eliminated to cover cost of disability legislation

    Bob GattyWashingtonJust over a year ago, the Office of Inspector General (OIG) of the Department of Health and Human Services issued a report declaring that Medicare payments for vacuum erection systems (VES) were “grossly excessive” and recommended steps to remedy the situation.

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    Specifically, the OIG said the Centers for Medicare & Medicaid Services should establish a special payment limit or seek legislative authority to include VES in the Medicare Competitive Bidding Program and then implement a National Mail-Order Competitive Bidding Program for the systems as well.

    OIG: $14.4 million savings lost

    The OIG said if Medicare had paid the same rates for VES as non-Medicare payers, the federal government would have saved an average of $14.4 million for each of the 6 years reviewed in its investigation, and Medicare beneficiaries would have saved about $3.6 million annually.

    While the OIG said it could not calculate precise cost savings that would be achieved through the Competitive Bidding Program, it noted that CMS had announced that its latest round of competitive bidding will reduce prices by 45% for certain types of durable medical equipment, prosthetics, orthotics, and supplies and by 72% for mail-order diabetic testing supplies nationwide. 

    CMS concurred with the recommendations.

    Nearly a year after the Dec. 30, 2013 date of that report, Congress—yes, the dysfunctional, highly partisan U.S. Congress—gave final approval to H.R. 647, the Achieving a Better Life Experience (ABLE) Act, which establishes a program for disabled individuals to obtain tax-exempt accounts so they can pay for qualified disability expenses.

    The ABLE Act, passed with bipartisan support by that rancor-filled Congress that couldn’t do much of anything else except bicker, helps the families of disabled individuals save for health care costs, housing, lifelong education, and other needs. Under current law, a child diagnosed with a disability cannot have assets worth more than $2,000 or earn more than $680 per month without forfeiting Medicaid eligibility. Through the ABLE Act, tax-free savings accounts up to $100,000 can be set up to pay for disability-related expenses.

    Given the political situation in Congress, how did this bill, which is expected to cost $2 billion over 10 years, get passed?

    “The bill appeals to Democrats because we are protecting benefits and entitlement programs for people with disabilities, and it appeals to Republicans because this is a private-sector solution to a public-sector problem,” said Sara Hart Weir, interim president of the National Down Syndrome Society, which led the effort to build support.

    What’s not to like about finding a solution to help the disabled pay for health care expenses? What does that have to do with the controversy over VES payments?

    Next: Bill's offsets affect urologists

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    Bob Gatty
    Bob Gatty, a former congressional aide, covers news from Washington for Urology Times.

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