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10/26/2021 09:09 AM
Pennsylvania House of Representatives
https://www.legis.state.pa.us/cfdocs/Legis/CSM/showMemoPublic.cfm?chamber=H&SPick=20210&cosponId=35837
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House of Representatives
Session of 2021 - 2022 Regular Session

MEMORANDUM

Posted: June 9, 2021 02:20 PM
From: Representative Tommy Sankey
To: All House members
Subject: Fairness in Home Medical Supply Vendors
 
Recently, a disturbing model has emerged in the Home Medical Equipment industry. An insurer has entered into an arrangement with an individual home medical equipment (HME) company to manage all of its intake and referral requests for home medical equipment and supplies for all of the insurer’s Medicare, Medicaid and commercial plans. This model establishes the ability for the chosen provider to “self-refer,” meaning that the provider may choose to distribute equipment/supplies directly to the patients, or the company may forward the referral request to another in-network provider.
 
This model creates a platform in which the chosen Home Medical Equipment company is a direct competitor with other HME companies in the insurer’s network. Obviously, this gives one company a distinct unfair advantage over other providers in the network. There is great concern within the industry that this will lead to shrinking of provider panels, and decreased access and service quality for consumers. This is not an appropriate time, during a pandemic, to be altering patient care processes with a program that will likely cause interruption of normal referral processes for home medical equipment providers, and potential access-to-care and continuity of care issues.
 
In the near future, I intend to introduce legislation that would restrict health plans’ ability to construct these unfair and unnecessary contracting schemes, and “level the playing field” for the hundreds of Pennsylvania- based HME companies, who have worked for generations to build trusting relationships with some of the most vulnerable populations in our commonwealth. I hope you will join me in cosponsoring this crucial legislation.
 



Introduced as HB1726