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March 9, 2009 Volume 15, Number 10

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Table of Contents
- DeParle in Top Health Reform Post; More Public Forums Set
- March 17: Don’t Be Late for This Important Date
- CMS Coverage Decision Specifies Allowable Sleep Tests
- HomeCare Magazine Named as Official Publication of Medtrade Events
- RAC Program 'Devastating,' Gorski Says; NOC Workgroup Still Working

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

Headline News
DeParle in Top Health Reform Post; More Public Forums Set
WASHINGTON--For home medical equipment industry long-timers, it was, as the venerable Yogi Berra said, déjà vu all over again when President Obama tapped Nancy-Ann Min DeParle, former HCFA admnistrator, to lead the White House Office of Health Reform.

Obama also nominated Gov. Kathleen Sebelius, D-Kan., as Health and Human Services secretary. If Sebelius is confirmed, together the two women will oversee the crafting and implementation of the nation’s health reform effort.

The announcement came a month after former Sen. Tom Daschle, D-S.D., withdrew his nomination to head HHS following an admission he had failed to pay $128,000 in back taxes. Daschle also stepped away from the newly created White House office, which would have given him a dual role in directing the push for reform.

The president's health team got another setback when CNN's Dr. Sanjay Gupta, a neurosurgeon, recently withdrew as Obama’s nominee for surgeon general.

In announcing his new health care duo last week, Obama said health reform will require a commitment that focuses “on ideas that work to rein in costs, expand access and improve the quality of health care for the American people.”

The announcement labeled DeParle “one of the nation's leading experts on health care and regulatory issues.” In her new role, DeParle will act as a counselor to the president and is expected to coordinate White House reform efforts with Congress.

DeParle was the administrator of the Health Care Financing Administration, precursor to the current Centers for Medicare and Medicaid Services, when the first competitive bidding demonstration projects were implemented in October 1999. A year later to the day, she resigned her position, which she had held since 1997.

She had previously been associate director for health and personnel in the White House Office of Management and Budget and was commissioner of the Department of Human Services in Tennessee. In addition, she served on the Medicare Payment Advisory Commission (MedPAC), which advises Congress on Medicare reimbursement issues.

During DeParle's term at HCFA, the agency established new codes for oxygen concentrators, added supplier standards and began an effort to deal with Medicare fraud and abuse in its original proposal for a provider surety bond and additional site visits.

DeParle supported the DMEPOS competitive bidding initiative, saying the first demonstration in Polk County, Fla., achieved Medicare savings without compromising patient access to quality care. “Competition helps Medicare beneficiaries receive quality medical supplies at fair market prices,” she said at the time. “Old laws have forced Medicare to spend more for equipment than market prices or common sense should allow.”

In announcing the winners of the Polk County project, which resulted in reimbursement reductions of 13 to 31 percent in five product categories, DeParle said the results “show that competition can work for Medicare beneficiaries.”

DeParle’s background as a proponent of competitive bidding could be a concern to the home medical equipment sector, said Don Clayback, vice president of government relations for The MED Group in Lubbock, Texas. But, he added, “we have to see what her current view is on that once she gets into office and assimilates what’s been going on the last few years relative to competitive bidding. Certainly things have changed, and there are new facts.”

Since DeParle was at HCFA, CMS has carved signficant savings out of the HME industry, he noted.

Seth Johnson, vice president of government affairs for Pride Mobility, Exeter, Pa., agreed. “I’m not that concerned with Nancy-Ann DeParle having this elevated role as counselor to the president for health policy because there have been so many changes to the health care spectrum, especially when you look at the DME industry within that, since she was administrator of HCFA,” Johnson said. “One of the challenges we’ve always had with competitive bidding is that it sounds like motherhood and apple pie,” he continued, “but I think once we have an opportunity to go in there and bring [DeParle] up to speed on all these changes--which I'm confident she may be largely aware of--I think we will be able to make a very compelling case to her that will hopefully lead to some type of change as far as the future of competitive bidding.”

But Joan Cross, co-owner with her husband Alan of C&C Homecare in Bradenton, Fla., said she remembered DeParle during the implementaton of the competitive bidding demonstration project in Polk County and had hoped to see a non-bureaucrat in the new White House position. “I would have loved to have seen them give it to somebody with a nursing background [or] a physician ... I would like to have seen somebody [who was not a bureaucrat]. At least Sebelius has some experience in the field.”

Sebelius, who has served as Kansas governor since 2003, has championed universal health care in the state during her tenure but has not been able to achieve it. She also served as the state's Insurance Commissioner from 1994 to 2002, successfully blocking the Antehm-Blue Cross of Kansas merger on the theory--correct, it turned out--that premiums would rise under Anthem.

Her nomination was greeted with some optimism by many in the HME sector. Clayback said it was promising that Sebelius “has a pretty good relationship with Sen. Pat Roberts [R-Kan.], and he is attuned to some of the issues relative to the HME industry. I assume they have a working relationship, and that is a good thing going forward.”

AAHomecare reported in its Wednesday newsletter that many HME stakeholders in Kansas support Sebelius' nomination. “They personally think she will be great because she really understands the issues that we have in the Midwest--especially the rural communities,” Rose Schafhauser, executive director of the Midwest Association of Medical Equipment Services, told AAHomecare.

However, Sandra London-Leib, CEO of Advanced Homecare in Lawrence, Kan., was more cautious. “Do not look for any sweeping changes from her,” she said. “She will definitely be in agreement with the president. After hearing the president … talk about the bidding process for all government contracts and payments, it is very clear that competitive bidding will be the standard course of action for her department.”

On Thursday, the White House held a health care summit that brought together members of Congress and stakeholders from the health care and insurance industries--including DeParle--to discuss the reform effort. Participants ticked off various health care difficulties that require reformative action: the vagaries of health care costs around the country, out-of-control maplpractice costs, inflated health insurance costs, bloated prices for prescription drugs, a shortage of medical professionals, divergent standards of care.

While those at the summit might not have agreed on how to fix the health care woes, they did agree on one thing: Health care reform must be achieved.

On Friday, President Obama announced that a series of public health care reform forums would be held in California, Iowa, Michigan, North Carolina and Vermont as a follow-up to the White House summit. The forums will provide “an opportunity for Americans from all over the country to voice their concerns and ideas about reforming our health care system,” according to a White House press release.

“The time for reform is now and these regional forums are some of the key first steps toward breaking the stalemate we have been stuck in for far too long,” Obama said in the release. “The forums will bring together diverse groups of people all over the country who have a stake in reforming our health care system and ask them to put forward their best ideas about how we can bring down costs and expand coverage for American families.”

The president has said he wants to achieve health care reform by the end of this year.

How do you feel about President Obama’s plan/budget for health care reform? To vote in HomeCare's monthly Web poll, visit www.homecaremag.com.



March 17: Don’t Be Late for This Important Date
BALTIMORE--March 17 is more than St. Patrick’s Day this year. It’s the last day for commenting on CMS’ competitive bidding IFR, and the date of a special Open Door Forum on the surety bond requirement for DMEPOS providers.

On Jan. 16, CMS published an interim final rule that revives the Medicare competitive bidding program. The rule was scheduled to take effect Feb. 17, but the agency delayed its effective date until April 18 to give the Obama administration time for review. The original comment period for the rule--March 17--remains unchanged.

While the date delay gives the HME sector a temporary reprieve, said AAHomecare President Tyler Wilson, “everything about CMS' handling of the competitive bidding program from the very outset has been troubling.

"Starting with the mismanaged implementation in 2008, through the mischaracterization of the program as a fraud prevention effort, to the rush earlier this year on Jan. 16 to ramrod the program through under the cover of the previous administration on its very last day, CMS seems intent on being confrontational with the HME community. Now, with some respite in the process, I hope that CMS will circle back and conclude they should work with home care providers through the [Program Advisory and Oversight Committee] and other means to make sure the reimplementation is free of flaws.

"Or better yet," Wilson continued, "CMS should work with the HME community to convince Congress that the bidding program will harm beneficiaries and providers alike and should be scrapped."

The industry got a boost from Rep. Heath Shuler, D-N.C., who called for an end to DMEPOS bidding last month during a House Small Business subcommittee hearing. But CMS’ Laurence Wilson, who testified at the hearing, told committee members the Medicare Improvements for Patients and Providers Act--the law Congress passed to delay the program--also requires its relaunch in 2009. CMS intends to move forward with a rebid of Round One this year, he said.

Eliminating competitive bidding before it can be implemented again is a top industry priority because of “the clear harms it would inflict on patient access to care, quality of care, and on the nation’s home care infrastructure,” AAHomecare said in a Friday update. To gain momentum and unify messages, the association said it has outlined key government relations, grassroots and PR actions needed to stop the program.

Working with state associations, AAHomecare’s “roadmap” for ending competitive bidding includes outreach to consumer organizations for support, education of new members of Congress and the Obama administration, a media campaign and development of grassroots action at the state and individual provider level.

“Providers should ask their members of Congress ‘Do you support a selective contracting program that puts most of the bidders out of business, even if they agree to a lower price?’” Wilson suggested. “This anti-competitive bidding scheme is simply a government-mandated consolidation program that will systematically kill competition and reduce access and care for the growing number of Americans who need medical equipment, care and supplies at home.”

The association has unveiled a new Web page on competitive bidding issues at www.aahomecare.org/competitivebidding.

To submit electronic comments on the competitive bidding IFR, go to www.regulations.gov. Enter file code CMS-1561-IFC and click on "Go." The left-hand column of the next screen is headed “Narrow Results.” Under "Document Type," click on "Rules,” and that will take you to the actual rule. Click on "Send a Comment or Submission." Fill in the information required under "Submitter Information" and your comments. In your comments, refer to file code CMS-1561-IFC.

For additional information, see www.cms.hhs.gov/DMEPOSCompetitiveBid.

The rule may be viewed at http://edocket.access.gpo.gov/2009/pdf/E9-863.pdf.

CMS has also set March 17 as the date for a Special Open Door Forum detailing the surety bond requirement. The teleconference will be held from 2-3:30 pm ET.

On Dec. 29, the agency announced it would require providers to post a $50,000 surety bond and published a final rule on the requirement Jan. 2. Existing providers must comply by Oct. 2, 2009, while newly enrolling suppliers must have a bond in place by May 4, 2009.

According to the Open Door notice, CMS staff will discuss key provisions of the final rule, including exemptions to the surety bond requirement; implementation dates; the definition of a final adverse action; and elevated surety bond amounts. The session will also include a Q&A.

To participate by phone, call 800/837-1935 and reference Conference 88857015.

CMS Coverage Decision Specifies Allowable Sleep Tests
BALTIMORE--In a move to standardize sleep test coverage nationwide, CMS issued its final coverage decision regarding obstructive sleep apnea diagnostic tests on Tuesday.

The approved tests include both those administered in a sleep facility as well as in a home setting. Previously, local Medicare contractors established their own coverage policies, and they often varied from state to state.

“This coverage decision establishes nationally consistent coverage and assures that beneficiaries who have sleep apnea can be appropriately diagnosed and referred for treatment,” said acting CMS Administrator Charlene Frizzera in an agency statement.

In specifying which tests would be covered, CMS said it “finds that the evidence is sufficient to determine that the results of the sleep tests … can be used by a beneficiary’s treating physician to diagnose OSA, [and] that the use of such sleep testing technologies demonstrates improved health outcomes in Medicare beneficiaries who have OSA and receive the appropriate treatment.”

The following tests have been deemed “reasonable and necessary,” according to CMS:

--Type I Polysomnography is covered when used to aid the diagnosis of obstructive sleep apnea (OSA) in beneficiaries who have clinical signs and symptoms indicative of OSA if performed attended in a sleep lab facility.
--A Type II or a Type III sleep testing device is covered when used to aid the diagnosis of obstructive sleep apnea in beneficiaries who have clinical signs and symptoms indicative of OSA if performed unattended in or out of a sleep lab facility or attended in a sleep lab facility.
--A Type IV sleep testing device measuring three or more channels, one of which is airflow, is covered when used to aid the diagnosis of obstructive sleep apnea in beneficiaries who have signs and symptoms indicative of OSA if performed unattended in or out of a sleep lab facility or attended in a sleep lab facility.
--A sleep testing device measuring three or more channels that include actigraphy, oximetry, and peripheral arterial tone is covered when used to aid the diagnosis of obstructive sleep apnea in beneficiaries who have signs and symptoms indicative of OSA if performed unattended in or out of a sleep lab facility or attended in a sleep lab facility.

In the March 3 decision memorandum, CMS also said certain sleep test devices have been given 510(k) marketing clearance by the Food and Drug Administration.

Under a Medicare ruling issued last July, however, HME providers are prohibited from administering sleep tests, although some providers do offer sleep testing for non-Medicare patients. (See ”No MD? Then No Home Sleep Testing" in HomeCare Monday, July 21, 2008.)

To read the March 3 CMS decision, click here.

HomeCare Magazine Named as Official Publication of Medtrade Events
ALPHARETTA, Ga.--Nielsen Business Media, producer of Medtrade and Medtrade Spring, announces HomeCare magazine, a publication of Penton Media, is the official publication of Medtrade and Medtrade Spring. Medtrade and Medtrade Spring are the leading trade shows for the home medical equipment industry. Through its in-depth coverage of the HME industry, the award-winning HomeCare magazine has been a primary source of information for the home health care industry for over 30 years.

“The partnership with HomeCare is a mutually beneficial relationship between both parties,” says Kevin Gaffney, show director. “Through its comprehensive reporting of the HME industry, HomeCare provides vital information that ensures HME providers have the resources they need to succeed. Our goal with the Medtrade events is the same and, together, we can maximize these opportunities.”

HomeCare Publisher Gregg Herring acknowledges that the HME industry is now at a critical juncture, poised to undergo both tremendous change and tremendous growth.

“As the official publication of Medtrade, our new partnership with the industry’s premier events will allow us to bring even more resources to the table,” says Herring. “Our companies chose to partner because HomeCare and Medtrade complement one another very well. Both companies are focused on providing home health care professionals with the knowledge that can keep their businesses profitable and allow them to concentrate on patient care.”

Medtrade Spring will take place March 24–25 in Las Vegas and Medtrade 2009 will take place Oct. 12–15 in Atlanta. For more information on the events, visit medtrade.com.

About Nielsen Business Media
Nielsen Business Media, based in Alpharetta, Ga., is a leading market-focused provider of integrated information and sales and marketing solutions, helping businesses go to market more effectively and efficiently. Serving seven major market groups, and 30 industries, spanning the entertainment, media and marketing, retail, travel and performance, design, and life sciences industries, Nielsen Business Media provides business-to-business products and services in print, online and in person. With 42 publications, over 60 trade shows and 185 digital products and services, Nielsen Business Media offers insight, analysis and face-to-face contacts to help professionals better understand their markets, serve their customers and grow their businesses. For more information, please visit nielsen.com.

About Penton Media
Headquartered in New York, Penton Media is one of the nation’s largest business-to-business media and information companies, serving more than six million business professionals every month. Its market-leading brands are focused on 30 industries. The company was formed through the combination of PRISM BUSINESS MEDIA and PENTON MEDIA. Its growing portfolio includes 113 trade magazines, 145 Web sites, 96 industry trade shows and conferences and more than 500 information data products. The privately held company is owned by U.S. Equity Partners II, an investment fund sponsored by Wasserstein & Co., LP, its co-investors, and by MidOcean Partners. For additional information on the company and its businesses, visit penton.com.

With editorial offices in Atlanta, HomeCare’s family of products includes its monthly magazine, the HomeCare Monday weekly enewsletter, the HomeCareXTRA market-focused tabloid, the annual HomeCare Buyers’ Guide and HomeCareMag.com.

In Brief
RAC Program 'Devastating,' Gorski Says; NOC Workgroup Still Working

AAHomecare’s Walt Gorski, vice president of government affairs, spoke Friday at the National Medicare RAC Summit, a conference about the new Medicare Recovery Audit Contractor program. Under the program, the RACs will be paid a contingency fee based on the amount of the improper payments they ferret out and collect. After a three-year demonstration in six states found more than $900 million in overpayments, CMS has implemented permanent RACs, and the post-payment review program will roll out to all 50 states by Jan. 1, 2010.

“RACs are a duplication of efforts currently on the books, including CERT, OIG CERT, pre-pay PSC, NSC site inspections and other programs,” Gorski said. “This program will have a devastating impact on home care providers because we will be held responsible for what is in the medical record. AAHomecare believes there is a need for a new approach to stopping improper payments, focusing on better screening on the front end and denying entry into the Medicare program for entities that should not receive NPI numbers to begin with.”

Oxygen Workgroup Still Working
AAHomecare reported last week that its New Oxygen Coalition continues to work toward consensus on a plan for reform of the Medicare home oxygen benefit. A nine-member subcommittee working within the coalition has met several times, the association said, and hopes to have a final document for consideration within the next few weeks. With oxygen a potential target for additional cuts by Congress, the group is aiming for a plan that would repeal the 36-month cap, remove oxygen from competitive bidding and recognize service requirements for oxygen providers.

According to some in the workgroup, the main sticking point is agreement on the approach to oxygen payment. A plan from AAHomecare and the Council for Quality Respiratory Care includes a case mix-adjusted payment system, but alternatives have been offered by the Big Sky Association of Medical Equipment Services and Jason Rogers, president of the Georgia Association of Medical Equipment Services. For more, see “Oxygen Stakeholders Work toward Common Ground” in HomeCare Monday, Feb. 9.

CMS Clarifies Point on Accreditation
In a follow-up on a point about participating and non-participating providers that came up during a Special Open Door Forum on accreditation held earlier this year, CMS has made it clear: “In either case, participating and non-participating, Medicare providers/suppliers must bill Medicare on behalf of the beneficiary and must be accredited by Sept. 30, 2009, in order to retain their Medicare Part B billing privileges.” To read the clarification in full, click here.

Time's Up for Previous ABN
A reminder from Jurisdiction A DME MAC NHIC last week notes that mandatory use of the revised Advance Beneficiary Notice of Noncoverage began March 1. CMS introduced the revised ABN March 3, 2008, and in the year since, has permitted dual acceptability of the old versions or the revised version of the form. But as of March 1, CMS said it would no longer accept any previous versions of the form.

NAS Notes Narrative for Some O2 Claims
According to a notice from Noridian Administrative Services, the Jurisdiction D DME MAC, effective immediately, when billing for oxygen equipment for a break in billing, resulting in a date of service after 36 months from the initial date on the CMN, a narrative stating "extend CMN" should be submitted on the claim, along with an explanation of why there was a break in billing. To read the complete update, click here.

Pharmacists Push for Accreditation Exemption
Sens. John Tester, D-Mont., and Sam Brownback, R-Kan., have introduced the Access to Durable Medical Equipment Act of 2009, a bill that would add pharmacists to the list of 17 medical professionals that are exempted from Medicare Part B accreditation requirements. The bill is a companion to a House bill introduced earlier this year by Reps. Marion Berry, D-Ark., and Jerry Moran, R-Kan. In announcing the House bill, Berry pointed out that community pharmacists "are the only licensed medical professionals that must meet new CMS accreditation requirements as suppliers of DMEPOS" (see HomeCare Monday, Jan. 26).

But CMS’ Sandra Bastinelli, who has oversight of the agency’s DMEPOS accreditation program, has estimated there are 25,000 pharmacy locations already accredited. If a pharmacy bills Medicare Part B for DMEPOS, it must meet the Sept. 30, 2009, accreditation deadline, she said during an Open Door Forum Feb. 18.

Report Finds Too Many without Health Insurance
About 86.7 million Americans, or a third of those under age 65, lacked health insurance at some point during 2007 and 2008, according to a new report by Families USA, a consumer advocacy group. Released March 4, the report found about 60 percent of those without health insurance lacked coverage for nine months or longer, while about three-quarters lacked coverage for six months or longer. A quarter of those without coverage lacked it for all of 2007 and 2008, according to the report, "Americans at Risk: One In Three Uninsured."

Medtrade Spring Deal for HomeCare Monday Readers
There’s still time! When you’re signing up for Medtrade Spring, use Code Home2009 for $50 off your conference ticket if you register before the show. With more than 250 exhibitors and 70 educational sessions, the event is just around the corner on March 24-26 at the Las Vegas Convention Center. For more information, visit www.medtrade.com.

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

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