For more industry news, features and highlights from our latest issue, please visit our Web site at www.homecaremag.com.

Headline News
RATC Poised to Push for Rehab Carve Out
WASHINGTON--In an urgent race against time, the American Association for Homecare's Rehab and Assistive Technology Council is crafting a letter that implores HHS Secretary Michael Leavitt to exclude complex rehab from Medicare's competitive bidding project.

"We believe that the secretary has the authority to exempt Group 3 [complex rehab] from competitive bidding and plan to push that issue," said Tim Pederson of WestMed Rehab in Rapid City, S.D., new chair of the council.

Pederson said on Friday that the letter had not yet been finalized, but the RATC hopes to have it completed and sent sometime this week. That still gives the secretary time to act before CMS' bidding window closes on July 13, he said.

"All it takes is for the secretary to say so," Pederson said.

The letter will stress several reasons why complex rehab is not a good candidate for competitive bidding, which is set to be implemented in 10 cities next year and another 70 in 2009. Ten product categories, including rehab products, are included in the initial round.

"Our major point is that complex rehab should not be in the competitive bidding program. It's too individualized, it's too specialized, and frankly, the market is too small for significant savings to be demonstrated," Pederson said. "If we just look at the data from TriCenturion, that makes the case quite well. Less than 10 percent of power mobility in Jurisdictions A and B is Group 3 [complex rehab]. If less than 10 percent is Group 3, that indicates that complex rehab is not the root of the problem CMS is trying to solve."

Mandated by the Medicare Modernization Act, competitive bidding's goal is to gain "significant savings" in the purchase of home medical equipment. But RATC's position is that those savings have already been achieved in the sector, largely through last year's reimbursement reductions and coding changes.

"I think we have already achieved significant savings. Maybe CMS will see that when they get the first-round bids," said Pederson.

The letter comes as advocates for H.R. 2231--the Medicare Access to Complex Rehabilitation and Assistive Technology Act of 2007, introduced in May by Reps. Tom Allen, D-Maine, and Ron Lewis, R-Ky.--continue to push for its support on the Hill. The bill, which is backed by the National Coalition for Assistive and Rehab Technology, would carve rehab out of competitive bidding and "ensure that Medicare beneficiaries would continue to have access to appropriate complex rehab and assistive technology products," according to NCART.

"We fully support H.R. 2231," Pederson said. "[It] is an important legislative initiative. It would be very nice if that would pass and we would support that. But time is working against us. It's time to appeal directly to the secretary."

Pederson said he is convinced that officials at CMS understand the nature of complex rehab, but they have not communicated that knowledge to Leavitt. "They realize that it is quite a bit different from conventional home medical equipment and they understand what makes it different. But I don't think they have the urgency to share the differences with the secretary," Pederson said. "Being that no one else will do it, I think we must do it."

Meanwhile, Sen. Arlen Specter, R-Pa., has also written Leavitt championing a rehab carve-out. In a letter dated June 15, Specter wrote: "Due to the significant changes to the power wheelchair benefit that we worked closely on last year, which were implemented Nov. 15, 2006, and the resulting impact on beneficiary access, rehab power product categories should be removed from the initial phase of competitive bidding."

Specter also stated that "withdrawing standard and complex power wheelchairs from the initial phase of competitive bidding is in the best interest of America's seniors and disabled."

Seth Johnson, former RATC chair and vice president of government affairs for Pride Mobility Products, Exeter, Pa., said Pride has worked closely with Specter's office on mobility issues. "He is really a champion for the industry," Johnson said. "He understands the issues and is willing to get involved."

Johnson said he believes that the RATC letter and Specter's letter, combined with H.R. 2231, will help put a spotlight on the complex rehab issue. "Clearly, it is going to take a lot more [voices], but we need to continue to educate our legislators," he said.

The site is supported by the following organizations: the Rehabilitation Engineering and Assistive Technology Society of North America; the American Association for Homecare; the National Coalition for Assistive and Rehab Technology; the National Registry of Rehabilitation Technology Suppliers; ITEM Coalition, a group of national and state-based organizations that want to maintain access to assistive services and technologies; and the Clinician Task Force, a group of individuals who provide wheelchair seating and mobility services.

Two More Bidders Calls, Lots More Questions
BALTIMORE--Following a series of calls June 4-8, CMS held two additional teleconferences last week to clarify information for small providers and field questions related to the first round of competitive bidding--and there were a lot of them.

In Wednesday and Thursday sessions conducted by Palmetto GBA, CMS' Competitive Bidding Implementation Contractor, recurring themes came up in providers' queries about common ownership, financial documentation and capacity, among a wide range of subjects.

One caller raised the issue of problems with the online bidding system, a frequent complaint from providers since CMS opened its 60-day bid window May 15 (see HomeCare Monday, June 11).

"We're in the process of just getting started on putting all this online, and the system seems to continue to crash on us," the caller said. "We've spent two days on this already and none of our data's been accepted. Is there something that's going on that we're unaware of, or can you tell us when the system's up or when it's down?"

Suggesting that the caller might have entered the system when maintenance was being performed, a CBIC official said "whenever the system is going to be down for a significant period of time, we will have [an alert on the Web site]."

But the caller persisted. "Well, for example, today we've got five hours between myself and my partner into this, and when we hit the 'next' button, it just came back with an error ... All I'm trying to say is that you're talking about a lot of man-hours for you to get through the process, and it doesn't allow you to save anything along the way and so you lose all of that ... it's crashing before we even make it to the point [of being able to save]," he said.

CBIC officials told the provider to call the bidding help line.

A similar dialog resulted from a question about credit reports, which must be turned in with bids. "The report we want is called a commercial credit scoring report," the CBIC's chief accountant said. He said such reports are not available online and must be requested from a representative at the credit bureau.

But a number of companies have already bought credit reports without a commercial score because they didn't know they needed one, a caller pointed out. The matter "needs some pretty quick attention," he said.

The official explained that the CBIC didn't want to influence the use of one credit facility over another--it has approved Equifax, Experian, TransUnion and Dun & Bradstreet--but said that a clarification about the necessary commercial score would be posted to its Web site.

Responding to questions about capacity, CBIC staff members said while there was no formula they could give, providers' estimated capacity would only be used to determine whether there are enough providers to service beneficiaries across each bidding area but would not be used to rank bids.

Officials also clarified a point about network bids during the Wednesday conference, which focused on small suppliers. Repeating that it intends to award 30 percent of winning contracts to meet its small supplier target, the CBIC said network members will be considered individually, not collectively as a group.

For example, an official explained, "If there are 10 members of a network, that network will count as 10 small suppliers in the 30 percent small supplier target calculation. If we only need three small suppliers to meet our 30 percent goal, we will accept the entire network, thus achieving and exceeding our goal by awarding the contract to one network with 10 members."

The CBIC said transcripts and an audio replay of the calls would be available on its Web site at www.dmecompetitivebid.com.

For additional questions, the CBIC instructed providers to call the bidding help line at (877) 577-5331 or e-mail cbic.admin@palmettogba.com.

To view the withdrawal notice, published in the June 18 Federal Register, click here.

AAHomecare Runs Roll Call Letter Urging Better Fraud Effort
WASHINGTON--The American Association for Homecare published an open letter to Congress Wednesday in Roll Call, a popular Capitol Hill newspaper, charging that the government has not done its job in curbing DME fraud.

While Congress has "finally enacted" provider accreditation and quality standards, the association said, the letter calls for a congressional review of the program's existing processes for approving providers.

According to the letter: "Medicare and its private contractors have failed to shoulder the proper responsibility to effectively exercise their already-existing authority to combat fraudulent activity. They must insist on standards and other up-front controls that will deny illegitimate operators any chance of taking advantage of Medicare ...

"Congress must review Medicare's existing processes for approving new durable medical equipment providers and auditing them after their supplier numbers are granted by CMS. Medicare's Program Integrity Unit and Program Safeguard Contractors already have tools at their disposal to inspect, monitor and audit such providers."

Referring to reports of rampant fraud in South Florida, the letter continued, "It is clear that such systems failed in Miami, where a number of fraudulent operations were recently shut down." (See HomeCare Monday, April 2.)

The letter also said providers need "clear, up-to-date and fair federal regulations that effectively target fraud and abuse but at the same time do not unduly burden those companies that make every effort to follow the rules."

At its recent Washington Legislative Conference, AAHomecare President Tyler Wilson suggested that new providers entering the system be granted only temporary supplier numbers and be placed on "100 percent prepayment review," with an onsite visit from the National Supplier Clearinghouse within a year.

"The sad fact is that in some quarters in Washington, tales of a tiny percentage of home medical equipment fraudsters wag the entire dog when it comes to home care policy," Wilson said, noting that reports of fraud detract lawmakers' attention from "the immediate, critical threats to home care" such as competitive bidding and additional cuts to oxygen.

The full text of the letter is available at www.aahomecare.org.

Study Shows One of Every Eight Health Care Dollars Spent on Diabetes in 2005
WASHINGTON--One out of every eight federal health care dollars in 2005 was spent on treating people with diabetes, according to a study released Tuesday by the National Changing Diabetes Program.

The study, presented at a Capitol Hill briefing, found that diabetes care cost the government nearly $80 billion in 2005, and researchers said it could get worse: "Without strong federal leadership, the human and economic costs of diabetes and its complications--at least some of which are avoidable or controllable--will continue to mount."

To remedy the situation, diabetes advocates called on Congress to create a "National Changing Diabetes Coordinator" to oversee spending and align efforts to combat the disease across federal agencies. They also said diabetes screening and early detection should be a priority in all federal programs, particularly Medicare and Medicaid.

Since 1980, the number of Americans with diabetes has doubled to more than 20 million, and that number is projected to double again by 2025. Complications from the disease--including heart disease, high blood pressure, stroke, blindness, amputation and renal disease--are largely preventable with proper management and treatment, according to researchers.

But the study said the government is missing opportunities for prevention and early detection of diabetes and its risk factors, that programs already in place meant to promote these goals are underused and that there is little cooperation among federal programs to fight the disease.

According to the study, the government spends about $4 billion on diabetes prevention and health promotion programs, only one-twentieth the amount spent on treatment. While virtually every department in the federal government--18 out of 21--has some level of spending that impacts diabetes, the study found, there is "a serious lack of coordination" across the various agencies and programs.

"We are spending as much on diabetes as we are on the entire Department of Education, but no one is leading the effort," said Dana Haza, senior director of the NCDP, a prevention and treatment initiative of Danish insulin manufacturer Novo Nordisk.

Neither a new Medicare diabetes screening program that could increase the number of early detections or a 10-year-old self-management program that helps diabetes patients monitor their glucose levels are being used to the extent they should be, the study said.

"Coordinating America's response to diabetes should be mandatory," said Lana Vukovljak, CEO of the American Association of Diabetes Educators, who presented recommendations from diabetes advocates in response to the study. "Over the next 30 years, diabetes is expected to claim the lives of 62 million Americans. Surely this health crisis warrants the appointment of a manager charged with aligning budgets and programs for diabetes at the federal level."

Conducted by Mathematica Research, the full report is available at http://www.ncdp.com.