“It is everyone's hope that the tragedy that is the post-Ike situation in Greater Houston will remind Congress of the great importance that medical equipment providers play in the daily lives of patients nationwide.”

Awake In America Replaces CPAPs Lost in Hurricane
PHILADELPHIA--Victims of Hurricane Ike who lost or left their CPAPs behind may be able to get their equipment replaced thanks to a disaster relief program operated by Awake In America.

The non-profit group, which focuses on sleep and sleep disorder issues, said its Operation Restore CPAP provides direct assistance to individuals who left their homes under emergency conditions, whether under a mandatory evacuation order or those who, thinking they would be home shortly after the hurricane passed, left their belongings behind.

Operation Restore CPAP is the only disaster relief program of its kind in the nation, assisting individuals who have been diagnosed with sleep apnea and had been using a CPAP or bi-level device at the time of the disaster, according to a statement from the group.

"We're hoping those hurricane victims with apnea will find the many battles for replacing homes, furniture, vehicles and many other essentials of life a little easier because of our program," said Michele Narcavage, president of Awake In America. "By quickly replacing the CPAP or bi-level devices used by people with sleep apnea to treat this potentially life-threatening disorder, we're hoping to help these people--victims of a major disaster--get the proper sleep they need without risking their health or life."

Supported by individual and corporate donations, Awake In America initially launched Operation Restore CPAP in 2005 as a response to Hurricane Katrina.

For more information about the program, visit the Awake in America Web site at www.awakeinamerica.info.

CMS Cautions Providers on Oxygen Equipment Rules
BALTIMORE--In an Open Door Forum Wednesday, CMS included a caution on repeal of the oxygen equipment transfer called for under the Medicare Improvements for Patients and Providers Act--although the agency didn't answer any of the myriad questions providers have raised about the impending 36-month rental cap.

“Obviously, we are still very much aware of recent changes in the statutes required by MIPPA, mainly the transfer of ownership of oxygen equipment and the delay of the competitive bidding program,” said Joel Kaiser, CMS deputy director of DMEPOS policy. “We are still analyzing these provisions, still planning for implementation of these provisions. We are still in the planning stages.”

Under the new law, providers will maintain ownership of oxygen equipment, but the 36-month rental cap, imposed by the Deficit Reduction Act, remains, and is set to take effect Jan. 1. CMS has yet to address how service and maintenance will be paid after the equipment has capped. (See HomeCare Monday, Aug. 25.)

Further information on CMS' plans will be announced “soon,” Kaiser said.

He emphasized, however, that while the transfer of ownership had been repealed under MIPPA, “there are other requirements that have not been repealed.” Under federal regulation 42 CFR 414.226 (g) (2), for example, providers are still prohibited from replacing oxygen equipment during the 36-month rental period, he said. There are some exceptions, he added:

--If a physician orders different equipment;
--If the patient elects to upgrade to newer technology;
--Or if equipment is lost, stolen, being repaired, no longer works or suffers irreparable damage.

Kaiser indicated some problems with HME providers not abiding by the regulation.

“We will follow up on individual cases and remedy the situation in some way if the problems continue,” he warned.

In an update on accreditation, CMS' Sandra Bastinelli offered clarification on a question posed during a previous teleconference: Does a federally-qualified health center that provides DMEPOS need to be accredited by the Sept. 30, 2009, deadline established for all DME providers?

“The quick answer is yes, you would need to be accredited by Sept. 30, 2009,” Bastinelli said, adding that because the center provides home medical equipment, it would need to adhere to the same requirements as HME providers.

She said CMS will host a conference Oct. 14 for DMEPOS providers who are not accredited. The conference, “Compliance with the DMEPOS Quality Standards: What You Need to Know,” will be held at CMS' Baltimore headquarters at 7500 Security Blvd. For more information, go to www.cms.hhs.gov/apps/events/event.asp and click on “Upcoming Events.”

Agency officials also reminded listeners that beginning March 1, 2009, DME MACs will accept only properly completed revised Advance Beneficiary Notices as valid notification. Currently, the MACS accept either ABN-G and ABN-L or the revised ABN.

Round One Providers Get Adjustments; Collecting Copays Could Be Tough
BOCA RATON, Fla.--Sylvia Toscano, president of Professional Medical Administrators in Boca Raton, Fla., told members of the Accredited Medical Equipment Providers Association last week that Cigna Government Services, the Jurisdiction C DME MAC, had issued remittances reflecting adjustments for underpaid claims based on the two-week implementation of the DMEPOS competitive bidding program, which began July 1 and was halted July 15.

Toscano said she discovered the adjustments while reviewing new Explanation of Medical Benefit (EOMB) statements for her round one clients.

According to Toscano, the notices carried the following remark codes:

--M112, The approved amount is based on the maximum allowance for this item under the DMEPOS Competitive Bidding Demonstration;
--M113, Our records indicate that this patient began using this service(s) prior to the current round of DMEPOS Competitive Bidding Demonstration. Therefore, the approved amount is based on the allowance in effect prior to this round of bidding for this item; and
--M114, This service was processed in accordance with rules and guidelines under the Competitive Bidding Demonstration Project.

Though the adjustment will bring over 26 percent of the revenue back to providers who billed in the first half of July, they may not be able to collect everything they are owed, according to AMEPA. Toscano believes collecting the copayments from beneficiaries and secondary insurance companies will be very difficult. She also noted that patients may be confused after already paying the prior coinsurance amounts when they receive an additional bill for the adjusted difference.

Walt Gorski, vice president, government relations, for the American Association for Homecare, agreed. "While CMS is paying the claims at the full 80 percent as if the competitive bidding program didn’t go into effect, collecting the additional copays from the beneficiaries is going to be the more difficult aspect [for providers]," he said. “It will be difficult for the beneficiaries to understand."

Lincoln, Snowe Introduce Bill to Cover Home Infusion
WASHINGTON--Sens. Blanche Lincoln, D-Ark, and Olympia Snowe, R-Maine, introduced a bill last week that would provide coverage for infusion-related services, supplies and equipment under Medicare Part B while leaving coverage of the drugs used in infusions under Part D.

The Medicare Home Infusion Therapy Coverage Act of 2008 (S. 3505) would close a gap in coverage “that nearly everyone--patients, physicians, caregivers, infusion pharmacists, nurses and even CMS--agrees needs to be fixed,” according to a press release from the National Home Infusion Association.

Infusion therapy involves the administration of medication through a needle or catheter, and is prescribed for many serious diseases when only infusible drugs are appropriate treatment, the NHIA said. Diseases commonly requiring infusion therapy include infections unresponsive to oral antibiotics, cancer and cancer-related pain, dehydration, gastrointestinal diseases or disorders that prevent normal functioning of the gastrointestinal system, congestive heart failure, Crohn's disease, hemophilia, immune deficiencies, multiple sclerosis, rheumatoid arthritis and more.

“Private insurers have been covering home infusion therapy for decades because they recognize that being treated at home is safer, more convenient, better for patients and is less costly,” said Russ Bodoff, NHIA’s executive director. “It is good for patients and it is good medical practice.”

But until now, Medicare has tended to cover the drugs and biologics used in infusions but not the medical services, supplies or equipment needed to deliver the home therapy. As a result, Medicare patients have had to enter a hospital or nursing home for the infusion treatment to be covered by their Medicare insurance.

“Home infusion therapy is covered by private insurers because they see the tremendous value, and Medicare beneficiaries deserve no less,” said Lincoln. “I urge my colleagues in the Senate to support this legislation, which would lower costs and improve the quality of life for patients who want to have access to these therapies in their homes. In fact, this is really the direction we need to take throughout the American health care system. We need a system that is efficient, geared toward the real needs of individual patients and cost effective.”

Snowe noted the legislation would simultaneously reduce costs to Medicare while improving care for older Americans. “Unnecessary institutional treatment simply makes no sense when patients can be treated in the comfort of their home--and at lower cost to Medicare,” she said.

John Magnuson, NHIA vice president of legislative affairs, noted that “Home infusion therapy offers many patients the freedom to be treated where they work and live. Congress needs to act now so that older people today and the large number of baby boomers tomorrow can receive care at home, and do not need to face the risks and discomforts of institutional care.”

The bill has been referred to the Senate Finance Committee.

Major Health Care Reform on Tap for 2009
WASHINGTON--On Thursday, Sen. Edward Kennedy, D-Mass., chairman of the Health, Education, Labor and Pensions Committee, strategized from his home with Democratic committee members in a videoconference about sweeping legislation in 2009 to overhaul the U.S. health care system.

The Senate HELP committee will have a big role in any health care overhaul effort, and though he has been diagnosed with brain cancer, Kennedy has told colleagues he expects to return to the chamber in January to lead the effort.

On Tuesday, the Senate Finance Committee--which oversees Medicare and Medicaid in that chamber--held its own hearing as part of a series on health care reform, with this one focused on better coordination of patient care.

Witnesses told the committee that integrated delivery systems could help cut health care costs and improve quality, but that Medicare and private payers are slowing integration because they don't reward the efficient delivery of care.

In hearing testimony, Robert A. Berenson, senior fellow at the Urban Institute, told committee members that the present health care payment system pits providers against each other and prevents them from working together to deliver better quality care.

And in his testimony, Medicare Payment Advisory Commission (MedPAC) Executive Director Mark E. Miller said, “The health care delivery system we see today is not a true system: care coordination is rare, specialist care is favored over primary care, quality of care is often poor and costs are high and increasing at an unsustainable rate ...

“Providers need to increase care coordination and be jointly accountable for quality and resource use. The objective is a delivery system that is focused on the beneficiary, improves quality and controls spending,” Miller said.

He went on to note that the fee-for-service payment system is not designed to reward higher quality and in some cases rewards providers “who increase the volume of services they provide regardless of the benefit of the service.” This, Miller said, leads to high costs for care including avoidable hospital readmissions, lack of coordinated care and follow-up and unnecessary tests and procedures.

“The process of reform should begin as soon as possible--reform will take many years, and Medicare's financial sustainability is deteriorating,” Miller concluded.

Witnesses also noted medical homes could be a way to integrate care, but that the concept should be thoroughly tested to make sure it works. Incorporating electronic medical records into a medical home system would be critical to its success, they said.

“At the Finance Committee, we've had our noses to the grindstone on health reform all year, and I intend to keep a strong focus on reform issues as Congress returns to Washington this fall,” Committee Chairman Max Baucus, D-Mont., said in a statement. “The crisis in America's health care system is growing and Americans are ready for reform. The climate will be right for change next year.”

Medtrade Returns to Atlanta for 29th Annual Expo
ATLANTA--Get set for business as HME professionals take over the Georgia World Congress Center Oct. 27-30 for Medtrade 2008. With a hefty educational schedule along with new products and services from 600 exhibitors, this year's Conference and Expo promises to be a one-stop shop for everything HME.

Chart the future at Medtrade's keynote session, called “Opportunities and Challenges Ahead-The State of the HME Industry.” The session, free to all attendees, will feature a panel discussion on the outlook for Medicare policy, trends that will impact the industry going forward, top legislative battles for 2009, challenges facing HME providers and manufacturers and advocacy events.

The discussion will be moderated by American Association for Homecare President and CEO Tyler Wilson, and panelists include:

• Cara Bachenheimer, senior vice president of government relations, Invacare Corp.
• Georgetta Blackburn, vice president of government relations, Blackburn's
• Lawrence Higby, CEO, Apria Healthcare Group
• Alan Landauer, CEO, Landauer Metropolitan
• Scott Meuser, chairman and CEO, Pride Mobility Products
• John Miclot, president and CEO, Respironics

For more information on the event, visit www.medtrade.com. And while you're at the show, stop by to see the HomeCare staff in Booth 3314. See you there!

HME Company Newswire
HME Company Newswire
Accelerated Care Acquires Neuroflex Orthotics
RENO, Nev.--A subsidiary of Accelerated Care Plus Corp. said Thursday it had finalized the purchase of Neuroflex Orthotics, Aliso Viejo, Calif. The acquisition was the first for ACP Medical Supply Corp., which was founded earlier this year to support ACP's expansion into durable medical equipment.

"One of our key initiatives for 2008 was to enter the DME market in order to provide a broader range of rehabilitation products and services to our client-partners," said ACP CEO John Beach. "We've used Neuroflex specialty orthotics in our clinical programs for over a decade and seen excellent results. Given their favorable impact on treatment outcomes, and their compatibility with our existing treatment programs, they were a natural fit for our new DME division and our core business."

The Neuroflex product line includes a range of splints, braces and appliances for the elbow, wrist, hand, finger, knee and ankle joints.

Specialty orthotic devices are used in several of ACP's specialized treatment programs, which are developed around proprietary medical technology called physical agent modalities. These devices include electrical stimulation, patterned electrical neuromuscular stimulation (PENS), therapeutic ultrasound, infrared therapy and short-wave diathermy. The company said the non-invasive, medication-free programs are developed around the needs of aging adults.

Neuroflex President John Kenny will join ACP Medical Supply Corp. as corporate orthotist. Said Kenny, "We've worked with ACP for many years and seen their presence in long-term care rehabilitation continue to grow. This is an opportunity to see our technology really hit its stride and benefit a much broader patient population."

In addition to the Neuroflex acquisition, ACP and ACP Medical Supply Corp. is planning other DME efforts including the upcoming launch of its new Omnistim FX2 Portable stimulator, a small electrical stimulation device incorporating the company's PENS technology that can be used by home patients to help manage pain and address disuse muscle atrophy.

Neighborhood Diabetes Buys New York Diabetic Supply
WOBURN, Mass.--Neighborhood Diabetes has increased its presence in the five boroughs of New York City with the purchase of New York Diabetic Supply. New York Diabetic Supply (NYDS, also known as Shelbourn Chemists), is headquartered in Brooklyn, and has been a leading supplier of glucose testing supplies and insulin pumps and pump supplies in New York City for over 20 years.

Neighborhood Diabetes, a portfolio company of Salix Ventures, a private investment firm, is one of the largest diabetic health care suppliers in the U.S., providing direct-to-consumer mail order diabetes testing supplies and educational services to the country’s growing diabetic population.

Central Capital Co. acted as financial advisor in the transaction.

In Brief
AAH Works on Anti-Fraud Strategy; CMS Launches Caregiver Initiative
The American Association for Homecare said last week it is working on a legislative strategy that will help keep criminals out of Medicare. According to the AAHomecare newsletter, association staff is reviewing specific measures that CMS could use to stop fraud at the front end of the payment process rather than relying on the current “pay-and-chase” system. AAHomecare said the measures “focus on increased scrutiny of new HME providers, real-time claims analysis and accreditation, among other topics.”

CMS launched a new Web site Thursday called “Ask Medicare” as a support for caregivers who take care of the disabled, elderly family members or friends on Medicare. The Web site, at www.medicare.gov/caregivers, provides access to health care information and services with links to resources and CMS partner organizations that assist beneficiaries. The site also has tools to help caregivers address common problems and answers questions to help beneficiaries make better use of Medicare. As part of its caregiver initiative, CMS will also launch a new “Ask Medicare” e-newsletter in November. More than 44 million Americans, or one in five adults, provide care to a loved one, friend or neighbor, valued at $350 billion annually, according to AARP.

On Friday, CMS announced the standard Medicare Part B monthly premium will be $96.40 in 2009, the same as for 2008. This is the first year since 2000 that there has been no increase in the standard premium over the prior year. By law, the premium is set to cover approximately one-fourth of the average cost of Part B services incurred by beneficiaries, with the remaining costs financed by federal general revenues.

Beginning today, CMS’ Medicare Learning Network (MLN) Learning Management System will be unavailable for approximately seven to 10 days for system maintenance and upgrades. Questions may be sent to MLN@cms.hhs.gov.

New data suggest that 35,000 to 70,000 people developed posttraumatic stress disorder, and 3,800 to 12,600 people may have developed asthma as a result of the 9/11 terrorist attacks. Seven years after the event, an analysis from New York City's Department of Mental Health and Hygiene examined health effects among 71,437 participants of the World Trade Center Health Registry, which includes rescue and recovery workers, Lower Manhattan residents, area workers, commuters and passersby. While it is difficult to pinpoint the total number of people sickened by the attacks, the report said, based on registry data it estimates more than 400,000 people were heavily exposed to the disaster.

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

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