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Headline News
Bill to Amend 'In the Home' Language Introduced
WASHINGTON--Bipartisan legislation introduced in the Senate last week calls for lifting Medicare's controversial "in-the-home" restriction for coverage of wheelchairs.

The Medicare Independent Living Act of 2006 (S. 3677), introduced by Sen. Jeff Bingaman, R-N.M., would eliminate the restriction and provide coverage for wheelchairs used outside of the home if it is determined that there is sufficient need due to the patient's medical condition.

The current interpretation of Medicare's in-the-home language covers devices that assist in activities of daily living such as eating, bathing, grooming, toileting and dressing, effectively restricting coverage to wheelchairs used inside a beneficiary's home.

Specifically, the bill would amend section 1861(n) of the Social Security Act, 42 U.S.C., by adding that coverage would also be provided "in the case of mobility devices required by persons with expected long-term need, used in customary settings for the purposes of normal domestic, vocational and community activities."

"Wheelchairs make it possible for otherwise homebound individuals to have the freedom and opportunity to get around outside their homes," Bingaman said. "This bill allows people with disabilities to live independently in their community, and I hope my colleagues in the Senate support it."

Rep. Rick Santorum, R-Pa., the sole Republican co-sponsor of the bill, said that he "will continue to advocate for an equitable Medicare payment policy for power wheelchairs that ensures patient access to these power mobility devices."

The bill also has six other co-sponsors--including Sens. Daniel Akaka, D-Hawaii; Tom Harkin, D-Iowa; James Jeffords, I-Vt.; John Kerry, D-Mass.; Joe Lieberman, D-Conn.; and Patty Murray, D-Wash.--but advocates are hopeful about gaining additional support for the measure and getting a companion bill in the House.

Last year, Bingaman was one of 34 senators and 70 representatives who signed a letter to HHS asking that the in-the-home restriction be modified through the regulatory process. But the government said that legislation would be required to make the appropriate changes, prompting Bingaman to author the new bill.

Seth Johnson, vice president for government relations at Pride Mobility and chair of the American Association for Homecare's Rehab and Assistive Technology Council, said the legislation is "extremely positive for all Americans with disabilities or mobility impairments."

To view the text of S. 3677, visit http://thomas.loc.gov.

To view the text of H.R. 5791, visit http://thomas.loc.gov.

VGM Study: Hobson-Tanner Won't Alter NCB Savings
WATERLOO, Iowa--If the Hobson-Tanner bill takes effect, it would not significantly change the savings the government can expect from national competitive bidding, according to a study commissioned by The VGM Group.

Economist Kenneth Brown, Ph.D., a University of Northern Iowa associate professor, conducted the study on the possible impact of the bill, H.R. 3559, which aims to protect small suppliers under the Medicare DME bidding program.

"H.R. 3559, which would allow small businesses to participate in the market without submitting winning bids, will have little or no impact on the recent cost savings estimate for competitive bidding for DME," said Brown. "Overall, I believe this provision will be beneficial to the overall DME market, particularly in terms of product and service quality, without adversely impacting the savings from the competitive bidding program."

John Gallagher, VGM's vice president of government relations, called Brown's report a strong statement in support of the Hobson-Tanner measure and a companion bill that is expected to be introduced in the Senate. "Dr. Brown takes away one of the leading arguments against 3559 by concluding that the cost of allowing any qualifying willing provider is very small and should not be a deterrent to passage," Gallagher said.

According to Brown, because the bill would allow qualified small providers to continue to serve Medicare beneficiaries if they submit bids that are less than the existing fee schedule, it would reduce the number of providers trying to submit winning bids. However, the number of remaining bidders would still be significant enough to result in the lower pricing sought by Congress and CMS.

Brown's report also said the Hobson-Tanner legislation would provide a built-in incentive for providers to exceed minimum standards to maintain market share. Under the current competitive bidding model, he noted, beneficiary choice is limited, thereby reducing quality.

In his report to VGM, Brown also evaluated the current projections for CMS savings under the DME-related provisions of the Medicare Modernization Act, the 2003 law that created competitive bidding and other reimbursement cuts. Of the original $9.9 billion in savings the CBO envisioned with payment reductions for DME, 70 percent of that total has already been achieved via a freeze on the annual inflationary update and cuts related to the Federal Employee Health Benefit Plans, Brown noted. Only 30 percent of the prospective savings is still available to achieve, he said.

"One must wonder if the costs of implementing [competitive bidding] and the costs to the industry, especially the small business, justify its implementation," Brown added.

In a previous study released last year, Brown concluded that after administrative costs, CMS would only save thousands through competitive bidding instead of the millions it had projected.

According to Mike Mallaro, VGM's CFO and president of its Last Chance for Patient Choice advocacy effort, Brown "reached a clear and definitive conclusion that this bill has little or no impact on government savings and it results in better product and service quality. VGM has believed all along that the best HME market is one where providers compete daily on quality and service and all willing, qualified providers are allowed to serve people in need of medical equipment."

Also last week, the NCPA announced that it has joined the National Association of Chain Drug Stores to create a lobbying body called the Coalition for Community Pharmacy Action. According to a press release, "all of the nation's 55,000 community pharmacies--both chain and independent--will be represented with a single voice on legislative and regulatory issues of common interest."

CMS to Target Medicaid Fraud and Abuse
BALTIMORE--CMS has launched a new program aimed at detecting and preventing Medicaid fraud and abuse, the agency announced Tuesday.

The new Medicaid Integrity Program will "yield significant Medicaid savings to help sustain the program," CMS Administrator Mark McClellan said.

"Together with our state partners, we are implementing unprecedented steps to assure that Medicaid funds do not support criminal activities within the system," he continued. "With rising health care costs, Medicaid funds are needed more than ever to care for the 55 million vulnerable Americans who depend upon it for their health care."

The fraud program was created by the Deficit Reduction Act with funds that will rise from $5 million in 2007 to $75 million by fiscal year 2009 and each year thereafter. Congress specifically required the use of contractors to review the actions of those who request payment from Medicaid, conduct audits, identify overpayments and educate providers on program integrity and quality of care. Congress also mandated that the agency devote at least 100 full-time staff to the project, which will be implemented in collaboration with state Medicaid officials.

The new Medicaid program will coordinate with the Medicare Program Integrity group on projects such as Medi-Medi, a pilot project that shares data to detect improper billing and utilization patterns, and the Payment Error Rate Measurement Program, which calculates payment error rates.

Total expenditures for Medicaid, which is funded jointly by states and the federal government, are expected to top $300 billion this year.

In Brief

More than 29 deaths across the nation have been attributed to the heat wave sweeping the United States, and home care providers are stepping up efforts to make sure their patients are safe. Temperatures last week soared, reaching the 90s and 100s in at least 46 states, leaving seniors particularly vulnerable since their age, conditions and medications give them a decreased ability to regulate body temperature. For a Centers for Disease Control fact sheet on extreme heat that includes recommendations for keeping seniors cool and symptoms to look for, click here.

The Certification Commission for Healthcare Information Technology has certified 20 systems that provide electronic health records for ambulatory or outpatient care institutions. The certification "removes a significant barrier to widespread adoption of electronic health records" and "gives health care providers peace of mind" about the functionality and quality of EHR technology, HHS Secretary Mike Leavitt said. Next steps are to certify products for inpatient, or hospital EHRs, then for systems enabling information exchange among health care providers and institutions. HHS awarded $2.7 million last year to the nonprofit commission to develop a way to certify health care IT products. HHS will soon publish rules creating anti-kickback and referral law exceptions to spur the health care industry to adopt the technology, Leavitt said.

Coming Up
VGM will hold Sales Training University in Philadelphia Wednesday and Thursday. For more information, call (866) 227-8171 or visit www.vgmeducation.com.

The Virginia Association of Durable Medical Equipment Companies (VADMEC) will hold its summer meeting in Virginia Beach, Va., Wednesday through Friday. For more information, call (919) 387-1221 or visit www.vadmec.org.

The American Association for Homecare will hold a teleconference on working with Congress Aug. 8 at 2 p.m. EDT. For more information, click here.

CMS Regions IV and VI will hold an "E-Prescribing Pilot" teleconference from 1 to 2 p.m. EDT Aug. 2. To participate, call (877) 203-0044 15 minutes before the call start time and use conference ID 2512410.

CMS Regions IV and VI will hold an "Electronic Health Records-RHIO Perspective" teleconference from 1 to 2 p.m. EDT Aug. 16. To participate, call (877) 203-0044 15 minutes before the call start time and use conference ID 2512447.

The Arizona Medical Equipment Suppliers Association (AZMESA) will hold its annual conference in Phoenix Aug. 17. For more information, call (651) 439-2944.

VGM will hold Sales Training University in Indianapolis Aug. 22-23. For more information, call (866) 227-8171 or visit www.vgmeducation.com.

Dynamic Seminars & Consulting will hold its "Tools for Handling That First Impression" teleconference Aug. 29. For more information, call (954) 435-8182 or visit www.dynamicseminars.com.

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