Invacare, Pride Team Up to Change Mobility Policies
WASHINGTON--Two of HME's largest manufacturers are working together to persuade CMS to alter one of its recent controversial power mobility policies.

In a Nov. 14 letter to CMS officials, Cara Bachenheimer, vice president, government relations, for Invacare Corp., Elyria, Ohio, and Dan Meuser, president of Pride-USA, Exeter, Pa., detailed their concerns with the interim final rule for power mobility devices and offered up suggestions that they said would help the industry serve beneficiaries.

The IFR, which took effect Oct. 25, eliminated the certificate of medical necessity for PMDs. Providers are now only required to submit a physician's prescription with their claims; however, they are required to gather patient records from physicians documenting medical necessity for the equipment (see HomeCare Monday, Aug. 29).

While Invacare and Pride said they support aspects of the IFR, such as a physician face-to-face examination and home assessment to make sure the device is functional in the patient's home, their main concern is with physicians' new documentation responsibilities.

According to the letter, addressed to CMS Deputy Administrator Leslie Norwalk and CMS Director Herb Kuhn, the companies are concerned that physicians may provide weak supporting documentation with their signed prescriptions, leaving providers unintentionally non-compliant. If a review finds the equipment was not medically necessary, the provider would be responsible for refunding Medicare.

Also, certain inconsistencies between the IFR and local coverage determination released by the DMERCs could cause further confusion, the companies said.

"These inconsistencies between the IFR and LCD can lead the DMERCs to a subjective interpretation of the patient's medical record and could ultimately give the DMERCs the ability to deny any PMD claim in an audit," the letter stated.

The companies also are asking CMS to extend the timeframe from when the face-to-face exam takes place to the time a provider is given a written prescription from 30 to 60 days. "We understand from our customers that this timeframe may not provide adequate time for the process to be completed. Under previous policy, providers would routinely need to follow up with physicians on numerous occasions just to obtain a prescription and completed CMN," the companies explained.

Another major concern with the IFR, according to Invacare and Pride, is that it could be easier for unscrupulous suppliers to defraud Medicare because a physician-signed document no longer needs to be submitted with PMD claims.

"We strongly urge CMS to put an appropriate mechanism in place on the front end of the claims system, which will strengthen program integrity efforts and provide beneficiaries and providers with some level of assurance that when a claim is paid, Medicare has approved the claim," the companies explained. This could include a standardized series of questions that physicians use to provide medical necessity information. A physician "attestation statement" indicating the necessary information has been completed, included in the medical record and provided to the supplier could be submitted electronically with the PMD claim, the letter suggested.

In the meantime, industry groups are divided over a proposed amendment to the HHS spending bill that would rescind the IFR and delay its implementation until April 2006 (see HomeCare Monday, Oct. 31).

While many in the industry, including Pride and Invacare, strongly support a delay, the National Coalition for Assistive and Rehab Technology opposes rescinding the IFR, saying a delay would only confuse the situation further.

Introduced by Sen. Arlen Specter, R-Pa., the amendment was included in the most recent versions of the bill from both the House of Representatives and the Senate. The original amendment included a 1.5 percent reduction in power wheelchair reimbursement as a way to pay for the delay--an estimated $10 million--but the provision has been removed from the current version.

Although the bill was unexpectedly defeated last week by the House and sent back to the negotiating table by the Senate, "we've been given pretty strong assurances our amendment will be in final bill," said Seth Johnson, director of government affairs for Pride Mobility.

AAHomecare Faults CMS' Proposed Quality Standards
ALEXANDRIA, Va.--In a letter to CMS Administrator Mark McClellan, the American Association for Homecare called the agency's proposed quality standards for suppliers "overly prescriptive" and urged the release of more details on accreditation.

The 24-page letter outlines the organization's concerns and recommendations for the draft standards, which were released Sept. 23 by CMS and its contractor Abt Associates, Cambridge, Mass. Expected to be finalized next year, the quality standards will be required of providers in the 10 cities where Medicare competitive bidding will begin in 2007--and eventually, of all DMEPOS suppliers who want to do business with Medicare (see HomeCare Monday, Sept. 26).

CMS' draft document focuses on two areas: business standards and product-specific requirements for items from oxygen and power wheelchairs to commodes and canes.

These details go too far, AAHomecare said, recommending that CMS eliminate detailed product standards for specific items and noting that some standards duplicate those already required by federal, state and local law. "CMS may have misunderstood the discussion by the [Program Advisory and Oversight Committee] about the need for product-specific standards. Certain lines of service such as respiratory, rehab and assistive technology, or infusion require specific standards to meet the needs of patients. This does not mean that every item of DMEPOS requires its own special set of standards."

Furthermore, the standards leave little room for the provider to exercise judgment when offering service, the association said. "Standards should establish the benchmark that a provider must meet, but should not be so specific that they dictate care or service."

In current form, the association continued, the standards are more like a checklist or operating manual, which "dilutes the value of accreditation."

AAHomecare also urged CMS to reveal more details about how it intends to implement mandatory accreditation. Agency officials have previously indicated that providers who are already accredited may have the opportunity to be grandfathered in, but have yet to issue specific details. The uncertainty has made many providers hesitant to begin the accreditation process, according to the association. "A clear policy statement from CMS on this issue favors all stakeholders and will encourage providers to seek accreditation now, promoting a smooth transition when all the standards are final," the letter stated.

Other suggestions by AAHomecare include:
--clarifying the role of the National Supplier Clearinghouse so providers are not subject to conflicting interpretations of standards;
--developing definitions for some of the terms in the draft standards and using them consistently. For example, "licensed," "certified," "credentialed" and "qualified" are all used in the same document, but no definition is given to differentiate the terms;
--resolving inconsistencies with Medicare reimbursement, coverage and billing requirements;
--eliminating the requirement that providers operate 40 hours a week, as long as a provider maintains appropriate access for emergency or an urgent after-hours contact;
--eliminating the blanket prohibition on using mail order delivery for all medical equipment;
--modifying the requirement that a provider should respond within 60 minutes of a beneficiary service call;
--eliminating the requirement that providers maintain financial records that comply with general accepted accounting principles;
--eliminating the requirement that a provider notify CMS and its accreditation organization when it first becomes aware of potential adverse financial operations;
--eliminating the requirement that providers establish a service plan for devices in Class I, which includes canes and walkers.

In Brief
Gov. Rod Blagojevich signed his All Kids plan into law on Wednesday, making Illinois the nation's first state to provide comprehensive affordable health insurance for every child in the state. Set to take effect July 1, 2006, the plan will give parents of some 253,000 uninsured Illinois children access to affordable coverage. All Kids will provide comprehensive services including doctor visits, hospital stays, prescription drugs, vision and dental care, plus medical devices such as asthma inhalers. Families of children in the program will pay monthly premiums and copayments for doctor visits and prescriptions, with rates based on income.

According to a Medicare Payment Advisory Commission analyst, continued growth in Medicare spending could trigger a funding warning that would require special legislation. Speaking at a MedPAC meeting last week, Rachel Schmidt said this year's Medicare Trustees Report projected that general revenues would exceed 45 percent of Medicare spending by 2012. Per a requirement in the Medicare Modernization Act, if the warning is issued two years in a row, the president would have to submit legislation to Congress to eliminate the excess funding. While Schmidt said MedPAC's approach is to improve program efficiency without lowering access or quality, she noted other alternatives include setting limits on benefits through a higher age eligibility, higher beneficiary premiums or using general tax revenues to fund the program.

A poll by the Kaiser Family Foundation shows six out of 10 seniors say they don't understand Medicare's new prescription drug benefit, and more than four in 10 are not sure they will sign up. Enrollment in the new drug benefit began last Tuesday. For those who sign up by Dec. 31, coverage begins on Jan. 1, 2006.

An official with the HHS Office of Inspector General's Office of Investigations said the size and scope of the new Medicare drug program leaves the new Part D vulnerable to fraud. Speaking on a panel at the National Health Care Anti-Fraud Association's annual training conference, John Bettac proposed that determining the true out-of-pocket expenses of Part D participants is largely dependent on a complex electronic tracking system. If the system is not ready when Part D begins in January, CMS will still have to pay claims, which will present opportunities for fraud, he said. He also said there may not be enough agents to uncover beneficiary fraud, since the federal government is focused on provider fraud.

Coming Up
The American Association for Respiratory Care (AARC) will hold the 51st International Respiratory Congress Dec. 3-6 in San Antonio. For more information, call (972) 243-2272 or visit www.aarc.org.

CMS will hold a Home Health, Hospice and DME Open Door Forum Dec. 6 at 2 p.m. EST. To participate in person, e-mail HOMEHEALTH_HOSPICE_DMEODF-L@cms.hhs.gov. To participate by phone, call (800) 837-1935 before the conference begins. For more information or for the conference ID number, which has not been posted, visit www.cms.hhs.gov/opendoor.

VGM Learn will hold Sales Training University Dec. 6-7 in St. Louis. For more information, call (800) 642-6065 or visit www.vgm.com/learn/sales.asp.

The New England Medical Equipment Dealers Association (NEMED) will hold its Winter Membership and Educational Meeting Dec. 8 in Boxborough, Mass. For more information, call (508) 993-0700 or visit www.nemed.org.

To revisit this news any time during the week, go to http://www.homecaremonday.com.