Industry Providers Express Concerns at SBA Regulatory Fairness Hearing

Last month, the Small Business Administration (SBA) held a Regulatory Fairness Hearing to receive feedback from small business owners about the regulatory environment. Stakeholders from the durable medical equipment (DME), complex rehab technology (CRT), and women’s health industries came together at this hearing and testified on behalf of their businesses and how current regulations affect their ability to provide proper care to their patients. Some current regulations make it difficult for patients to receive proper care and access to equipment vital to their mobility. This hearing was very beneficial for industry stakeholders to advocate for the well-being of their businesses and, most importantly, the customers and patients they serve.

One issue that these providers experience is when their businesses are contracted to provide durable medical equipment to Medicaid recipients under the CMS authorized state managed care model. Some of these Managed Care Organizations (MCOs) are not effective and can lead to providers being unable to supply necessary equipment to the patients who need it. Georgie Blackburn of Blackburn’s explained, “We have witnessed significant barriers to access for recipients in need for durable medical equipment. Having contracted with all MCOs in our state, we can compare the effectiveness, efficiencies, and, most importantly, the timeliness of care. MCOs simply do not operate in a similar manner, and states do not effectively monitor comparable activity.”

Another issue that affects many providers’ ability to provide proper care and access to equipment is Medicare’s reimbursement for CRT accessories. John Letizia of Laurel Medical Supplies, Inc. explained that, as an independent supplier, his company prides itself on the service that they provide to their customers. However, CMS’s flawed pricing policy is affecting their ability to provide service to their power wheelchair customers. Power wheelchairs and their accessories are crucial for the patient’s mobility, and because of CMS’s current policy, some of these critical components are harder to come by.  

Jasmine Jones of Cherry Blossom Intimates and Nikki Jensen of Essentially Women spoke about the importance of allowing coverage of custom breast prosthesis for mastectomy patients. Jensen said that testifying at the National Ombudsmen SBA Hearing was a great opportunity to educate more people within CMS about the disconnect in existing regulation that prohibits an additional non-surgical option for women who have experienced breast cancer. Custom breast prosthesis is not covered by Medicare, and this limits the options that women have following a mastectomy. The hope is that CMS will be able to make a regulatory fix and allow custom breast prostheses as an eligible benefit for those who have experienced a mastectomy.

All issues that were discussed at this hearing hinder the ability for patients to receive timely, appropriate care. The SBA Hearing was a great opportunity to express the many concerns about regulations within the home medical equipment (HME) industry that create business challenges and barriers and prevent access to care. A special thanks to all of the medical equipment suppliers who testified or attended in support of the industry. These testimonies will help CMS understand that regulations must be improved for patients to receive the best care possible. To help spread this message, take action at https://people-for-quality-care.rallycongress.net/ and let your member of Congress know that you deserve proper access to services and supplies.