Additional information about Hurricane Gustav, including a complete list of common questions and answers, and several other announcements with hurricane information are posted at www.cms.hhs.gov/Emergency/02_Hurricanes.asp.

Palin’s Advocacy Pledge Inspires Respect, Reproach
MINNEAPOLIS--Newly named vice presidential candidate Sarah Palin fanned a small flame of hope for support for children with disabilities during her acceptance speech at the Republican National Convention Wednesday night, but stakeholders burned by decades of broken promises are mostly taking a wait-and-see attitude.

Palin, whose youngest son, Trig, was born with Down syndrome in April, spoke about her baby boy in the speech, noting that the greatest joys in families can often bring the greatest challenges.

“Children with special needs inspire a special love,” she said. “To the families of special-needs children all across the country, I have a message: For years, you sought to make America a more welcoming place for your sons and daughters. I pledge to you that if we are elected, you will have a friend and advocate in the White House.”

That pledge sparked heartfelt responses across the country through Web site conversations, polls and even a Newsweek Web exclusive.

Organizations focused on aiding parents and their children with special needs wondered, at least momentarily, if Palin’s comment could someday evolve into money being funneled into services for those with disabilities. Mostly, however, they were gratified that Palin had spoken up at all about the issue.

“We’re delighted that she has brought this to the public’s attention,” said Sara Brewster, vice president, marketing communications, for Easter Seals. “It is important for people with disabilities that this is on a legislative agenda. What’s important to us is that people are aware that children with disabilities have tremendous needs. The sooner we can begin to provide services for them, the better the outcomes are.”

Sheila Hebein, executive director of the National Association for Down Syndrome, was more tempered in her enthusiasm. She’s been contacted by People magazine, CNN and various other television stations asking for comments, she said.

“I think we are getting off track here, because Sarah is not running for president,” she said.

Still, she noted, the publicity is positive. “She’s created some good public awareness. She has a cute baby and he was up there and we celebrate that ... It helps our families to see a baby in public like that,” Hebein, herself the mother of a young man with Down syndrome, said. “But I haven’t seen any meat on that statement. It’s too early.”

On About.com’s Special Needs Children blog by Terri Mauro, parents of children with special needs and even some of those children themselves weighed in with their thoughts on Palin’s comments:

“I am a parent of a special-needs child and having a voice and advocate in the White House is exciting,” wrote Kelly.

“I am not impressed by the little shout out we got in Sarah’s … speech,” Cleon wrote. “Do we really think that she will have the nerve or the power to take on Big Pharma or push spending away from the military to special education? Come on … I’ll wait to reserve judgment but [I] have no illusions that she would do anything of substance if she gets in the White House.”

And Kara, a special needs person herself, wrote, “I’m happy Palin pledged to be an advocate and ally for the families of children with special needs … How does she plan to do that? Simply having a child with a disability doesn’t make you a strong advocate …We don’t remain children forever and while my mom and dad appreciate the support, I think they’d rather she direct her disability efforts toward me--the person with a disability.”

For one mom writing on the blog site, though, Palin’s comment didn’t resonate as either rhetoric or a solemn promise. Instead, it opened the door of opportunity.

“If nothing else, I am grateful for the media’s attention on all of us, the parents of children with special needs, who have been quietly battling the school districts, the medical establishment and the insurance companies. This is our Warholian moment of fame, and we should use it [to educate] and inspire all Americans to support our children and our families thorough better government funding and insurance company regulations,” wrote Michelle.

A replay of the teleconference will be available Sept. 10 at www.cms.hhs.gov/OpenDoorForums/05_ODF_SpecialODF.asp.

Stakeholders Applaud RESNA Move to Combine ATS/ATP Certifications
ARLINGTON, Va.--After months of discussion and study, the Rehabilitation Engineering and Assistive Technology Society of North America has rolled out its plan to combine the Assistive Technology Supplier (ATS) and Assistive Technology Practitioner (ATP) certifications into one.

Unlike the current ATS and ATP designations, the new designation of Assistive Technology Professional (ATP) is not tied to a role, but instead “recognizes professionals who have reached an internationally accepted standard of knowledge in assistive technology and who adhere to RESNA's code of ethics and standards of practice,” according to RESNA officials. The change is effective Jan. 1, 2009.

“RESNA has made this change to clarify the purpose of certification, remove confusion that is caused when certification is tied to roles and to identify a core knowledge base in AT that is common to all individuals working in the service delivery model so that they can consult, refer and work with each other to best serve the needs of the consumer,” said Anjali Weber, the organization's director of certification.

Weber said RESNA will continue its scheduled ATS and ATP exams through the end of the year. Those earning the designations will automatically be transferred to the new designation, she said, and those already holding such certificates will be issued new ones with the redefined ATP designation. No additional testing or fees will be required.

An updated test designed for the new ATP certification will be released in January, and computer-based testing will also be implemented then, according to RESNA.

Assistive technology stakeholders largely applauded the move.

“We are in support of the consolidation. We think it is an appropriate move for the profession and the industry at this point,” said Simon Margolis, executive director of the National Registry of Rehabilitation Technology Suppliers.

He added, “There are going to be people who have reservations and who don't understand it. We have spent the last 13 years working toward role-based certification, so it's difficult to get your arms around.”

However, Margolis continued, NRRTS held a teleconference on the change with Laura Cohen, chair of RESNA's Professional Standards Board, and she was able to address many of the NRRTS members' questions and concerns.

Julie Piriano, director of rehabilitation industry affairs for Pride Mobility Products in Exeter, Pa., also supported the change.

“Overall, it's a positive move. I know that there is going to be some confusion initially because the current ATS/ATP is looking [at it] as a role that the individual plays in the team as opposed to a knowledge base,” she said. “But in the long run, it hopefully sets up the industry, especially complex rehab, to move more toward a positive continuum of care similar to orthotics and prosthetics.”

Piriano said she particularly welcomed the ability through the new designation to speak a common language with others in the industry. “It's very important to be speaking the same language with the providers, the clinicians, the researchers,” she said.

“It simplifies the confusion between the ATS and the ATP credential, and settling on the ATP was the right move, I think,” said Tim Pederson, president and CEO of WestMed Rehab in Rapid City, S.D., member of the American Association for Homecare's RATC and an ATS himself. “I see it as a good move. It takes the confusion out of the marketplace.”

Last year, CMS' DME Program Safeguard Contractors eliminated a requirement for a certified ATP to evaluate beneficiaries receiving certain power wheelchairs after industry stakeholders said the nationwide shortage of ATPs would result in an access issue for Medicare beneficiaries. (See HomeCare Monday, Dec. 11, 2007.)

Elimination of the ATP requirement, which had been set to take effect in April this year, drew mixed reviews, with Margolis saying at the time he felt the complex rehab and assistive technology profession had been “sold out.”

The new single designation changes all that, since it allows a baseline of knowledge, Margolis said.

“The rationale is that all people who are involved in seating and technology … need to have a certain baseline of knowledge [in whatever role they play]. This [designation] brings everything together and says, 'Here is the baseline.'”

The exciting aspect of the change, he and other stakeholders said, is that specialty certifications will be offered by RESNA.

“The first specialty in seating and mobility will be available in the second half of 2009, and the process for clinicians and for suppliers will be a separate one that is yet to be determined,” Weber said.

She added that not all areas of practice require specialty recognition; which ones do “will need to be identified by those practicing and recognizing the need.”

Margolis said NRRTS will be involved in helping to develop the specialty certification for seating and mobility.

“We want a specialty certification that is affordable, accessible and realistic,” he said. “It can't cost $600 and we have to be able to get to it. It has to be computer-based, using all the technology that's out there, that measures what we do. I think our involvement is going to be critical.”

Weber said specialty certification might not be through a test. “Recognition in the various practice areas may be awarded by many different pathways other than an exam, including certificate programs, continuing education and training, strict work experience or education requirements and more,” she said.

As it moves forward with the new certification program, RESNA will work with funding sources, employers and accrediting bodies to ensure that the appropriate policy changes are made, officials said.

Rotech Settles Whistleblower Case for $2 Million
ORLANDO, Fla.--Rotech Healthcare has paid $2 million to settle civil charges resulting from a whistleblower complaint that it engaged in fraudulent Medicare billing for durable medical equipment.

The settlement resolves claims filed in 2004 by former Rotech executive Sheila Bell-Messier, who alleged the company suppressed disclosure of billing issues in Texas, Colorado and Louisiana in order to avoid additional penalties related to a previous civil settlement. In 2002, while in bankruptcy, Rotech settled federal civil claims related to billing issues in its Montana, Kentucky, Florida and Georgia operations.

According to the unsealed qui tam action in the U.S. District Court for the Eastern District of Texas, Bell-Messier “shut down the billing” when she noticed that records were not in compliance with federal directives. A statement from attorneys Berg & Androphy, part of the legal team that represented Bell-Messier, said she was asked to restart billing but refused, saying she “was not going to Medicare prison for Rotech.”

Bell-Messier, of Texarkana, Texas, whose company had been purchased by Rotech in 1995, stayed on with the company and had overseen operations in 12 states.

In settling Bell-Messier’s claims, Rotech denied any wrongdoing. The federal government did not intervene in the case.

Of the total settlement, $2 million will go to the government, with Bell-Messier receiving 27 percent, or $540,000. Rotech will also pay her legal fees of $1.2 million.

DME MACs Score Below Average on Provider Satisfaction Survey
BALTIMORE--The results are in, and based on a survey of 35,866 health care providers, CMS has reported they are generally satisfied with the services provided by Medicare’s fee-for-service contractors.

The average score across all contractors on the agency’s third annual Medicare Contractor Provider Satisfaction Survey was 4.51 on a scale of 1 to 6, with 1 representing “not at all satisfied” and 6 meaning “completely satisfied.” All four DME MACs, however, fell below the national average with these scores: Noridian, 4.45; National Government Services (formerly ASF), 4.42; NHIC, 4.40; and Cigna, 4.36.

The DME MACs' average score was 4.41. Regional Home Health Intermediaries (RHHIs) received an average score of 4.68; Fiscal Intermediaries (FIs) and Part A Medicare Administrative Contractors (MACs) received an average score of 4.61; and Carriers and Part B MACs received an average score of 4.35.

Among provider types, hospice providers reported the highest level of satisfaction (4.74) and physician DMEPOS suppliers submitting DME claims reported the lowest (4.22).

The claims processing function received the highest scores among all contractor types, although the survey found 82 percent of respondents would like to see more training and education material on claims processing. The appeals function received the lowest survey scores.

In 2007, more than one billion claims were processed and paid to approximately one million health care providers who provided medically necessary items and services to 44 million beneficiaries.

A summary of the survey findings is available on the CMS Web site at www.cms.hhs.gov/MCPSS.

CMS Sets September Calls
BALTIMORE--On Wednesday, Sept. 10, beginning at 2 p.m. ET, CMS will conduct an Open Door Forum on the Special Needs Plan Chronic Condition Panel, which will determine the conditions that meet the definition of severe or disabling chronic conditions in accordance with the Medicare Improvements for Patients and Providers Act.

According to CMS, “We are most interested in comments related to identifying the set of chronic conditions having significant medical, psychosocial, mental, and functional effects that require specialized care as prescribed by the law. CMS encourages consideration of conditions that lend themselves to effective care management and service delivery under a capitated health plan arrangement. In addition to commenting on criteria the panel may use for selecting conditions, we urge commenters to also consider the need for face validity and administrative feasibility.”

To participate in the teleconference, call 800/837-1935 and reference Conference ID 62238545.

On Sept. 17, the agency has scheduled its next Home Health, Hospice & DME Open Door Forum beginning at 2 p.m. ET. To participate by phone, call 800/837-1935 and reference Conference ID 58369938. An audio recording of the session will be available at 800/642-1687 (use the same ID) beginning two hours after the call has ended. The recording expires after three business days.

And on Sept. 22 at 2 p.m. ET, CMS will hold a Town Hall meeting via conference call as well as in the auditorium at CMS headquarters (7500 Security Blvd., Baltimore, Md.) to get provider feedback on the possible next version of HIPAA standards for claims and other transactions as well as recovery auditing and Medicare Administrative Contractor (MAC) transitions. The meeting agenda and discussion materials will be available to download at www.cms.hhs.gov/center/provider.asp by Sept. 19.

To partcipate by phone or in person, you must pre-register for the meeting at http://registration.intercall.com/go/cms2. Registration will close Sept. 17.

In Brief
NAIMES Hits 100; Medi-Cal Cuts Back in Play
The National Association of Independent Medical Equipment Suppliers reported last week it now has 100 members and is on its way to the goal of having one proactive member in each of the 435 congressional districts. “As we grow towards this goal, NAIMES will be working with its members to help them become advocates and lobbyists for themselves and the industry,” said President Wayne Stanfield. “The certainty is that we must improve our image by improving our relationships in Congress, and that is our primary goal. We are passionate about this industry and its future. It is an honorable industry that deserved better outcomes than we have had in the past few years, and we intend to be the catalyst for improving those outcomes.” In a statement issued Tuesday, the group unveiled its “Warriors for DME” campaign, a PR and consumer awareness initiative. “We must reach the masses over the next eight weeks to bring the true face of DME to the attention of the public and more importantly, our legislators,” NAIMES said. In July, the organization launched its “Win at Home 2008” program to encourage suppliers to get involved and develop relationships with members of Congress before the November general election. For more information, visit www.dmehelp.org.

After the state argued that retroactive awards violate its constitution, U.S. District Judge Christina Snyder--who ordered California to reinstate Medi-Cal fees after a 10 percent reimbursement cut took effect July 1--has amended her ruling, requiring that the state repay providers only for services performed after Aug. 18. The state has also asked a federal appeals court to overturn the entire ruling, arguing that federal law does not entitle Medi-Cal providers or patients to challenge fee levels in court. In addition, according to an update from the California Association of Medical Product Suppliers, as much as $11.9 billion in scheduled payments for public services, including health care, could be blocked if the state’s budget impasse is not resolved by Sept. 26. The emergency fund used to pay Medi-Cal providers when the state is operating without a budget was depleted on July 24. (See HomeCare Monday, Aug. 25.)

With the Paralympic flame burning at the Temple of Heaven, the opening ceremony for the 2008 Paralympics was held Saturday at the Birds Nest in Beijing. Just two weeks after the Olympics, the Paralympics are a parallel games for athletes with a wide range of disabilities. More than 4,000 athletes representing 148 countries will use many of the same Olympic venues to compete in 472 medal events--170 more than the Olympics. The 10-day competition will run through Sept. 17. During the event, Elyria, Ohio-based Invacare and its Top End division have launched an online feature dedicated to Team Invacare athletes who are participating in the games. The Invacare Web site, at www.invacare.com, highlights racing, handcycling, tennis and basketball athletes. Viewers may click on their favorite event to read athlete bios and check out photos, and some of the athletes have video files posted. Representatives from Top End are attending the Paralympics, so the site will be updated regularly with medal counts and other news. For live coverage of some events, watch at www.UniversalSports.com.

The Washington-based Power Mobility Coalition has raised concerns about recent findings that question whether CMS accurately reviewed DME claims. In an Aug. 28 press release, the group said that a new report from HHS Office of Inspector General compared an OIG report and a CMS review of the same Medicare DME claims that showed “vastly different error rates. The CMS contractor assessed a 7.5 percent error rate while an OIG contractor assessed a 28.9 percent error rate." According to Stephen Azia, PMC counsel, ”It appears that there is inconsistency in determining what constitutes medical necessity for Medicare beneficiaries to obtain the equipment. The physician must be the gatekeeper of the PMD benefit and the veracity of his or her best medical judgment should not be second-guessed by a medical reviewer who has never seen or examined the beneficiary. These results just highlight what we have been concerned about for years.” The coalition of power mobility device manufacturers and providers also urged CMS to develop a new phase-in schedule for DMEPOS accreditation, which the agency dropped when competitive bidding was delayed. "Congress should make it clear to CMS that the delaying of competitive bidding was not meant to delay any mandatory accreditation requirements that can be useful in the fight against fraud," said Eric Sokol, PMC director. "PMC strongly urges that a new phase-in schedule should be developed and implemented immediately."

Air Products, Lehigh Valley, Pa., has completed the sale of its U.S. health care businesses, A&J Care and COPD Services, to Mt. Vernon, N.Y.-based Landauer Metropolitan Inc., the largest privately held home medical equipment company in the New York metropolitan area. Terms of the deal were not disclosed. In July, Air Products said it had reached preliminary agreement to sell A&J Care’s metropolitan New York operations in Glendale and Peekskill and COPD Services’ New Jersey operations in Runnemede, Cape May Courthouse and Cedar Grove. The 180 employees associated with these businesses have been offered employment with LMI.

Member services organization VGM Group, Waterloo, Iowa, announced it has split the revenues from 18 competitive bidding seminars held earlier this year with the co-sponsoring state associations. The average net revenue from each event was $5,500, and each participating state association received, on average, $2,700. As well as offering education to providers about competitive bidding, “we wanted to help state associations create revenue to fund their legislative activities and garner new membership,” John Gallagher, VGM’s vice president of government relations, said in a release.

A federal court in Tampa, Fla., sentenced Mabel and Abner Diaz to 14 years in prison Aug. 28 for their role in a $148 million Medicare DME billing scheme. In addition to the prison terms, the U.S. District Court for the Southern District of Florida ordered the defendants to pay restitution of nearly $126 million, according to a statement from U.S Attorney R. Alexander Acosta. A third defendant, Suleidy Cano, was sentenced to 11 years in prison and restitution of more than $117,000. In July, the Diazes each pleaded guilty to one count of conspiracy to commit health care fraud and one count of health care fraud related to the submissions by their Miami company, All-Med Billing Corp. Cano, who worked as a biller for All-Med, pleaded guilty to one count of conspiracy to commit health care fraud and one count of aggravated identity theft. Of nearly $420 million in fraudulent claims allegedly submitted by All-Med on behalf of 85 DME suppliers for equipment that was not ordered by physicians or delivered to beneficiaries, Medicare paid more than $148.5 million, the statement said.

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