Nearly half of the United States Senate has signed a letter seeking support for durable medical equipment providers in rural areas and in non-bid areas of Medicare’s controversial competitive bidding program.

The American Association for Homecare (AAHomecare) sent the letter, signed by 49 senators, to Health & Human Services Secretary Tom Price and Centers for Medicare & Medicaid Services (CMS) Administrator Seema Verma on July 13.

“As you know,” the letter stated, “the Patient Protection and Affordable Care Act required CMS to establish adjusted fee schedules for DME in non-competitively bid areas and to consider the costs of furnishing services in these areas. We are concerned that CMS did not fully consider the costs of providing DME in non-competitively bid areas or the length of time needed by providers to adjust to the change.”

The letter pointed out that funding cuts have gone into effect, and asks the Department of Health & Human Services to “swiftly use its regulatory authority to provide further relief in non-competitively bid areas.”

DME suppliers in rural areas face such business challenges as needing to travel long distances to deliver or service equipment to Medicare beneficiaries, the letter said. Additionally, there are relatively few suppliers available to provide service in large rural areas. Those factors were supposed to be among those considered by the Department before setting reimbursement amounts.

Legislation such as December’s 21st Century Cures Act demonstrated that Congress has ongoing concerns over Medicare’s competitive bidding system, the letter noted.

The letter was written by Sen. John Thune (R-S.D.) and Sen. Heidi Heitkamp (D-N.D.) and co-signed by 47 senators.