View this email as a Web page Please add HC_HomeCare Monday_ to your Safe Sender list.
A Penton Media Property
May 11, 2009 Volume 15, Number 20

ADVERTISEMENT

ADVERTISEMENT
Are Your Paper Files Safe?

Spring brings severe weather and we all know you can’t stop Mother Nature, but you can prevent her from shutting down your business by going paperless. WebScan PRO™ is a powerful, secure and cost-effective online document management solution that allows you to manage your documents anywhere, anytime from any web browser without installing any software.

Reap all the benefits of going paperless and breathe easier knowing your critical and sensitive data is safe and secure in our 100% HIPAA-secure servers.

Protect your business! Contact Ben at 866-885-2974 ext. 2009 or email bwheeler@remitdata.com to get started! www.remitdata.com

Table of Contents
- Stakeholders Scramble to Muster Support for HME Issues
- Senators Get STOP Act Started Again
- MACs Issue Travel Oxygen Article
- Count Another Hill Lobbyist for HME
- Florida Providers Defeat State Threats
- Air Products Sells Infusion Business to Walgreens’ OptionCare
- Pharmacies Push for Bond Exemption; Time for New CMS-855S

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

Headline News
Stakeholders Scramble to Muster Support for HME Issues
WASHINGTON--Stakeholders in the home medical equipment industry are pushing on multiple fronts to ensure the sector’s voice is heard as Congress begins crafting a comprehensive health care reform package, they said last week.

“There are four issues in the hopper: competitive bidding, oxygen reform and the oxygen rental cap, the 9.5 percent cut for complex rehab and fraud and abuse legislation,” said Don Clayback, vice president of government relations for Lubbock, Texas-based The MED Group. “Discussions are going on in all four of those camps.”

Beleaguered by a new round of nationwide competitive bidding, a 9.5 percent reimbursement cut--specifically in the narrow-margin complex rehab sector--and a 36-month oxygen rental cap, the industry is seeking relief and reform.

But how and where all those issues should be addressed is a question.

“We need immediate relief,” Clayback said, referring especially to the oxygen rental cap and the 9.5 reimbursement cut for complex rehab, which have created financial difficulties for providers and access problems for beneficiaries. “Unfortunately, although there might be some regulatory answers, we haven’t been able to shake them loose.”

Any sort of regulatory movement has been hampered by the fact that the Department for Health and Human Services was rudderless until last week when former Kansas Gov. Kathleen Sebelius was finally confirmed as secretary. But the top post at the Centers for Medicare and Medicaid Services is vacant and isn’t likely to be filled overnight, since any nominee for that position also must be confirmed by Congress.

Stakeholders have focused much of their attention on lawmakers in hopes that the various issues could be handled through legislation. In all likelihood, however, any legislation would need to be part of a larger bill.

“The thinking is that we are such a small piece that it isn’t like we can just introduce a free-standing bill. We really have to be attached to something,” Clayback said, adding that the two possibilities are the health care reform package and a Medicare overhaul bill.

Stakeholders have been encouraged by legislators such as Rep. Jason Altmire, D-Pa., who told HomeCare Monday he believes home health care could be a critical part of health care reform legislation.

“Research shows that home health care can be more cost effective than nursing homes,” Altmire said. “Currently, the Medicare reimbursement process does not incentivize home care, even though it can be cost effective. As part of comprehensive health care reform, I believe we should change the Medicare reimbursement process so that it is easier for those who wish to receive home care services to do so.”

By making quality home health care accessible, he said, “I believe that home medical equipment can help to lower our country’s health care costs in the long run.”

It’s that message that stakeholders are attempting to get across on all four fronts. Clayback said the industry hopes to have its approach on the four issues crystallized by June 1.

“When I say crystallized, I mean we need at least a clear direction so we can ask Congress for their support," Clayback said, adding that discussions are ongoing about what the industry will ask for specifically and what any legislative language will look like.

Competitive bidding: Numerous “Dear Colleague” and other letters have been sent to congressional leaders and key regulatory officials calling for rescission of the interim final rule reimplementing DMEPOS competitive bidding, which went into effect April 18.

"Our message on the Hill is that the IFR needs to be repealed because the fundamental flaws that were in last year are embedded in the one this year,” said Seth Johnson, vice president of government affairs for Exeter, Pa.-based Pride Mobility Products. “We’re continuing to make the case that the program needs to be stopped.

“If they want to move forward,” he continued, “they need to move in a much more transparent way and differently from the program that was rolled out last year.”

Some stakeholders are also hopeful that a regulatory stay could still occur. Sebelius said during her confirmation hearing that she would carefully review the program to ensure that the same problems did not remain that derailed the project when it was first instituted last July.

“I don’t think she is going to do that unless she gets enough support from Congress,” Clayback said bluntly, adding that the industry must continue to build congressional and regulatory support for halting the bid program.

Toward that end, the American Association for Homecare on Friday called for providers to contact their legislators with the following message: “Congress must stop the deeply flawed competitive bidding program for home care.” The association detailed several talking points to get the message across.

Oxygen reform and oxygen rental cap: AAHomecare is finalizing legislative language for its oxygen reform plan, which includes elimination of the oxygen rental cap. (See "Oxygen Reform Plan Moves Ahead," April 13.)

As well, separate legislation that would focus specifically on eliminating the oxygen cap is expected to be introduced "any day," sources said.

“The feeling of most folks is that the best way to get the cap fixed is [for it] to be part of an oxygen reform bill,” Clayback said. He added that discussions with members of Congress have been encouraging. “I think there has been some good interest, but basically they’ve said, ‘Let’s see what the legislation would look like.’”

Complex rehab carve-out from the 9.5 percent cut: With a margin as small as two percent, complex rehab providers are suffering under the 9.5 percent reimbursement cut, stakeholders said, and there is no relief in sight.

“We’re still continuing to build support from a consumer perspective and on Capitol Hill some language has been developed [to carve out complex rehab from the cut],” Johnson said. “The real problem is that the obvious vehicle [to attach legislation to] is the comprehensive Medicare bill, and none of us expect that to be finalized until the end of the year,” he said.

The Medicare reform issue does have a sense of urgency since physicians will be hit with a 21 percent cut on Jan. 1 unless legislation is passed to stop it.

Fraud and abuse: Last week Sens. Mel Martinez, R-Fla., and John Cornyn, R-Texas, introduced the Seniors and Taxpayers Obligation Protection Act (see story this issue). Martinez, as ranking member of the Senate Special Committee on Aging, also held a hearing to discuss ways to clamp down on Medicare fraud and abuse.

With so much activity on every issue, there are many details to sift through and decisions to make, Clayback noted.

“The complexity of the issues [means] there’s an awful lot of work that is going to have to be done before some bill is introduced,” he said. “But we don’t have months to strategize.”

For his part, Johnson said he was celebratingafter getting a look at President Barack Obama’s 2010 budget last week. “I’m celebrating specifically because for the first time in recent memory, there were no cuts in the budget to DME,” Johnson said.

Obama’s $3.6 trillion budget budget proposal calls for $309 billion in Medicare and Medicaid cuts over 10 years, proposes $17 billion in cuts in various departments and eliminates 121 programs. But no HHS health programs were proposed for cuts.

However, Johnson added, “I think the celebration will be short-lived because Congress has made it very clear that all the pay-fors that were not used for [the Medicare Improvements for Patients and Providers Act] are on the table this year. That includes elimination of the power wheelchair purchase option and further reductions to oxygen.”

Do you support the New Oxygen Coalition reform plan for Medicare's oxygen benefit? To vote in HomeCare's monthly Web poll, visit www.homecaremag.com.


Senators Get STOP Act Started Again
WASHINGTON--Sens. Mel Martinez, R-Fla., and John Cornyn, R-Texas, are trying again with the STOP Act and an accompanying bill aimed at preventing and stopping Medicare and Medicaid fraud.

On Tuesday, Martinez and Cornyn re-introduced the Seniors and Taxpayers Obligation Protection (STOP) Act (S. 975), which they said would give federal agencies the tools they need to crack down on Medicare fraud before it occurs. The senators had introduced the bill last June, but no action was taken. (See "STOP Act Aims to Curb Medicare Fraud," August 4, 2008.)

An accompanying measure called the Medicaid Accountability through Transparency, or MAT, Act (S. 974) will require transparency in billing for services and medical equipment.

Together, the two bills will help to improve HHS' detection methods and place billing statements under increased scrutiny, Martinez said.

"Entitlement program fraud is out of control,” said Martinez, ranking member of the Senate’s Special Committee on Aging. “Each year, criminal fraud in Medicare and Medicaid diverts billions away from programs that care for our nation's 43 million seniors and disabled persons. Especially in this time of limited resources and efforts to find savings, starting with the largest fraud makes sense. We need a proactive approach to tackle this problem, and that begins with efforts to bring transparency to the system and commonsense efforts to detect and prevent fraud."

On Wednesday, Martinez chaired a hearing on the subject with a number of witnesses, including R. Alexander Acosta, U.S. Attorney for the Southern District of Florida, an area where the Medicare Fraud Strike Force--a combination effort by the FBI, HHS’ Office of Inspector General and local law enforcement--has been active.

Acosta called the task force results “both sad and spectacular.” Operating since 2006, the anti-fraud force has brought cases against more than 700 individuals responsible for billing Medicare more than $2 billion. However, Acosta told the committee, “Prosections are not the answer.” The best way to prevent Medicare fraud, he said, is “to implement systemic changes at CMS … that are designed to identify and deny fraudulent bills.”

Among other measures, the STOP Act would require real-time analysis of claims data (similar to that used in the analysis of credit card charging patterns) to identify unusual billing or ordering practices that could indicate fraud or abuse.

The American Association for Homecare issued a statement applauding the STOP Act, which contains a number of points that mirror the association's recommendations for stopping fraud. Those points include both pre-enrollment and unannounced site visits for new HME providers; site visits for current providers that are re-enrolling, as well as an unannounced site visit after re-enrollment; and checks to ensure the provider is qualified and enrolled to bill the type of item or service on the claim.

Last year, AAHomecare presented its 13-point anti-fraud plan to Congress. (See “AAHomecare Offers 13-Point Plan to Stop Medicare Fraud,” Oct. 27, 2008.)

MACs Issue Travel Oxygen Article
ATLANTA--On Thursday, the DME MACs issued an article on travel oxygen related to short-term travel (days or weeks) and temporary relocation, such as for snowbirds.

Under a new payment policy for oxygen effective Jan. 1, the article notes, if a beneficiary travels or relocates outside the provider’s service area, “then for the remainder of the rental month for which it billed, the home supplier is required to provide the oxygen itself or arrange for a temporary supplier (non-billing) to provide the oxygen.”

“Historically, providers weren’t responsible for providing travel oxygen, and the patient had to make arrangements for that or pay on their own,” according to Lisa Smith, a health care attorney with Brown & Fortunato, Amarillo, Texas. “This is definitely changing that picture.

“If you have provided oxygen for a patient during a month Medicare pays for it, then you’re going to be required to provide travel oxygen as well.”

Additional requirements for home providers:

--For subsequent rental months that the beneficiary is outside the service area, the home supplier is encouraged to either provide or arrange for the oxygen itself or assist the beneficiary in finding a temporary supplier (billing) in the new location.
--If the home supplier provides oxygen to the patient for use out-of-area or arranges for a temporary supplier (non-billing) to provide the oxygen, the home supplier bills for whatever system the patient is using on the anniversary date/billing date. The supplier may provide the patient with different oxygen equipment (e.g., portable concentrator) for travel, if there is an order from the physician.
--The home supplier may not bill for or be reimbursed by Medicare if it is not providing oxygen or has not arranged for a temporary supplier (non-billing) to provide the oxygen on the anniversary billing date.

Requirements for temporary providers:

--If it is during a month in which the home supplier has not billed Medicare, claims from the temporary supplier (billing) would be paid, if all coverage criteria and payment rules are met.
--If it is during a month in which the home supplier has billed Medicare and it is not provided under an arrangement with the home supplier, then the claim from the temporary supplier (billing) will be denied as not medically necessary, if it bills Medicare.
--If the beneficiary returns home before the end of a rental month for which the temporary supplier (billing) has billed, it must provide oxygen itself for the entirety of that month or make arrangements with the home supplier to provide the oxygen.
--The temporary supplier (billing) must provide a copy of a valid CMN, an order (if the order information was not included on the CMN), a report of the qualifying blood gas study, and documentation of any required physician visit, if requested.

The article also gives instructions for providing oxygen in months 37 through 60:

--The supplier providing oxygen to the patient during the 36th month is required to provide oxygen to the patient either directly or under arrangements with a temporary supplier (non-billing) for beneficiary use out-of-area.
--The home supplier could provide the patient with different oxygen equipment (e.g., portable concentrator) for travel, if there is an order from the physician.
--The supplier would not submit a claim for that equipment (because it is required to continue to provide equipment after the 36 month cap).
--If the beneficiary had a gaseous or liquid system during the 36th month and the supplier was providing contents to the patient during months 37-60, it may only bill and will only be reimbursed for contents if the patient was using contents at some time during the billed month. It may not bill for contents if, for example, the beneficiary was using a portable concentrator during the entire month.

Smith, who recently authored a Q&A series on the 36-month oxygen cap and post-cap payment rules for HomeCare Monday, said she is asking CMS for clarification on billing for travel oxygen and other points in the MACs’ new instruction.

But one frustrated oxygen provider said the gist of the article is all too familiar: "It's one more thing that doesn't fix anything," said Bill Baker, RRT, of RxO2 in Tucson, Ariz. "It makes it worse. Nobody is going to touch a traveler. It's too much trouble."

Read the full travel oxygen article on the Jurisdiction C (Cigna) Web site.

Count Another Hill Lobbyist for HME
MARTINEZ, Ga.--Last week, the Committee to Save Independent HME Suppliers announced it has hired the Capitol Hill Consulting Group, a Washington, D.C., lobby firm. The focus of CSI:HME, the group said, is “to lobby Congress in support of legislation addressing the needs and goals of the thousands of independent small business providers across the nation.”

The recently formed group has also retained publicist Baker Wright Group to work in tandem with the lobby firm on commentary, provider stories and press releases for Capitol Hill publications. Additionally, Baker Wright will help craft PR materials for providers’ use at the local level about the value of home care and HME at no cost.

According to David Petsch, owner of Petsch Respiratory in Martinez (Augusta), Ga., managing director of CSI:HME, the group’s first priorities will be the repeal of competitive bidding and the 36-month oxygen cap.

“We’re talking about 90 percent of independent providers that may be left out of the competitive bidding program,” Petsch said, “and providers are now starting to see the impact the oxygen cap is having on their bottom lines. Now they are asking 'What can we do to help?'

“You just have to step out and say ‘This is important to me and I’m going to spend my dollars to represent my company and my family and my small business,’” he said.

While hiring a lobby firm is costly, Petsch continued, “I’m losing $10,000 to $15,000 a month with the cap, so why not take that money and try to get some control over the end result? If we’re all preaching the same message, it should be a positive voice.”

Other members of CSI’s executive committee include Shawn Steffey, president of Respiratory Care Associates, Winchester, Va.; Esta Willman, president of Medi-Source Equipment & Supply, Yucca Valley, Calif., and a member of CMS’ Program Advisory and Oversight Committee; and Todd Tyson, president of HiTech Healthcare, Norcross, Ga. The National Association of Independent Medical Equipment Suppliers, Halifax, Va., will handle administrative functions for the group.

According to Petsch, what he terms the “ancillary lobbying group” has budgeted for a year but will make a decision “down the road” on continuing its efforts. “Right now we’re waiting on CMS and Congress and the new administration to tell us what we are going to have to do survive,” he said.

“This is in no way, shape or form anything but recommending to people that we all get involved,” Petsch said. “There are a lot of disgruntled independents out there, but I will never give up fighting the fight.”

For information about the new group, email action@csihme.org.

Florida Providers Defeat State Threats
DORAL, Fla.--Florida HME providers are breathing easier this week after managing to sidestep several state legislative measures that, if allowed to pass, would have burdened providers and created access problems for beneficiaries, according to the Florida Alliance of Home Care Services.

In a Thursday update, FAHCS said providers had been successful in:

--Defeating a bid to authorize Medicaid to create a competitive bidding program for Medicaid waivers, specifically consumable supplies;

--Forestalling an attempt to amend a state appropriations bill that would have established competitive bidding for all Medicaid HME; and

--Eliminating language that would have mandated a statewide procurement bid by the Department of Health for prescriptive assistive devices over $2,500. (Prescriptive devices are defined as any complex rehab equipment that requires authorization, including wheelchairs, power chairs, stands and other assistive technology.)

Providers contacted every major elected official in the state to discuss the measures, FAHCS officials said.

“They told us two weeks ago that we didn’t have much of a chance, but by working together and working hard, we got Tallahassee’s attention,” said FAHCS President Roger Ribas. “We have it now and we will not let it go. This is good for everyone and I am so thankful for everyone’s efforts.”

FAHCS specifically thanked other HME associations for their help, including the American Association for Homecare, the Accredited Medical Equipment Providers of America and the Indiana state association, "all of which forwarded letters to Florida officials against competitive bidding," the update said.

Air Products Sells Infusion Business to Walgreens’ OptionCare
LEHIGH VALLEY, Pa.--Air Products announced last week the company has sold all of its U.S. home infusion therapy business and some elements of its respiratory and HME business to Walgreens subsidiary OptionCare Enterprises. Terms of the deal were not disclosed.

The transaction includes Air Products' interests in the home infusion therapy business of American Homecare Supply (Atlanta and northern Georgia); Ultra Care and Dependicare (Chicago); Rx Pharmacy Services and Mosso's Medical Supply Company (western Pennsylvania and Pittsburgh); Collins I.V. Care (Connecticut); and Air Products Healthcare Pharmacy (Lehigh Valley, Philadelphia and southern New Jersey).

Last July, Air Products said it planned to sell its U.S. Healthcare business, which had operations in 80 eastern U.S. locations. Based on a review of the market, the company said at the time, U.S. Healthcare no longer fit its business portfolio. (See "Air Products Looks to Sell U.S. Healthcare," July 28, 2008.)

Since, Landauer Metropolitan has bought Air Products’ A&J Care locations in New York and its COPD Services locations in New Jersey. ATG Rehab has acquired the Air Products Seating and Mobility division.

According to a release, the latest transaction represents nearly 50 percent of the remaining Air Products Healthcare Group portfolio and includes 15 locations with 550 employees serving about 25,000 patients.

With its $850 million blockbuster purchase of OptionCare in 2007, Walgreens catapulted into the top eschelon of the nation's home infusion players. In February this year, OptionCare acquired Tampa, Fla.-based CareMax Medical Resources, which offers home infusion, respiratory and DME in Colorado, Florida, Pennsylvania and Texas.

In Brief
Pharmacies Push for Bond Exemption; Time for New CMS-855S
Last Monday, Sens. Jon Tester, D-Mont., and Pat Roberts, R-Kan., introduced a companion bill to the Preserve Patient Access to Reputable DMEPOS Providers Act of 2009 (S. 956). A House version of the bill (H.R. 1970) was introduced April 2. The legislation would exempt pharmacies from having to post a $50,000 DMEPOS surety bond.

“The bond requirement should not apply to pharmacists, who are already subject to state regulations and are not associated with violations,” read a statement from Bruce T. Roberts, RPh, executive vice president and CEO of the National Community Pharmacists Association. “Fourteen other medical providers are already exempted from this time-consuming and expensive requirement, and this bill would add pharmacists to that list.” For more, see “Bill Would Exempt Pharmacists from Surety Bond,” April 13.

Time for New Application Form
According to CMS, effective June 1, DMEPOS suppliers submitting applications to Medicare must use the revised CMS-855S form or the application will be rejected. The revised form includes a 26th Supplier Standard: “All DMEPOS suppliers must obtain a surety bond in order to receive and retain a supplier billing number.” The revised form also includes a section for reporting surety bond information. The revised form is available here.

Senate Confirms Corr as HHS Deputy Secretary
On Wednesday, the Senate unanimously confirmed Bill Corr as deputy secretary of Health and Human Services. He fills the No. 2 spot at the department and will work with newly sworn-in HHS Secretary Kathleen Sebelius as the national debate on health reform heats up. Corr most recently served as executive director of the Campaign for Tobacco-Free Kids, and served as HHS chief of staff during the Clinton administration.

New Logo Launch for Pride
Pride Mobility Products Corp., Exeter, Pa., unveiled a new logo and tagline last week: Performance Mobility – Live Your Best. The new logo draws the correlation between Pride’s performance-based products and the consumer’s ability to lead an independent, active life, the company said. The logo and tagline will be used for all retail mobility and standard power products, which primarily target the geriatric market. “We want our mobility product users to live their best and encourage them to thrive and succeed in all aspects of their life,” said Scott Meuser, Pride chairman and CEO.

CDC Studies Health Workers in Flu Spread
In a Wednesday press briefing, Dr. Richard Besser, acting director of the Centers for Disease Control and Prevention, said the role of health workers in helping spread the H1N1 flu is getting a look. “When you’re thinking about risk, who comes in contact with the most individuals who are sick and have flu? Health care workers,” Besser said. With the disease in the United States turning out to be mild, Besser said CDC teams are already going back in to study its spread. The agency will look at the role of health care workers in Texas, California and Mexico.

Next Open Door Set May 13
CMS has scheduled its next Home Health, Hospice & DME Open Door Forum May 13 at 2 p.m. ET. To participate by phone, call 800/837-1935 and reference Conference ID 94280596.

Florida Home Care Conference
The Accredited Medical Equipment Providers of America and the newly formed Florida Alliance of Home Care Services have announced they will sponsor the Florida Home Care Conference on May 20 in Orlando. For information on the joint AMEPA-FAHCS one-day event, email info@fahcs.org or call 866/99-FAHCS.

Overview of HIPAA 5010
CMS has issued an MLN Matters Article outlining HIPAA 5010 changes and how providers need to plan. According to the agency, “implementation will require changes to the software, systems and perhaps procedures that you use for billing Medicare and other payers. So it is extremely important that you are aware of these HIPAA changes and plan for their implementation.” Read the overview in MLN Matters SE0904.

ResMed Reports Quarterly Results
ResMed, San Diego, has announced record revenue and income for the quarter ended March 31. Revenue for the 2009 quarter was $227.9 million, an 8 percent increase (a 16 percent increase on a constant currency basis) over the 2008 quarter. Income from operations was $52.5 million and net income was $39.2 million, an increase of 40 percent and 32 percent, respectively, compared to last year’s results. Earnings per share were $0.51, an increase of 34 percent over the same quarter in 2008.

Nurses, PAs Work against RLS
The Practicing Clinicians Exchange said last week it will partner with the Restless Legs Syndrome Foundation to provide continuing education programs to nurse practitioners and physician assistants on RLS. According to the PCE, one in 10 Americans has RLS, which is characterized by an irrestible urge to move th legs. Symptoms often occur at night, disrupting sleep and causing a reduced quality of life. "NPs and PAs provide patient-centered care that allows them to recognize RLS symptoms and appreciate the impact of the condition on those who suffer from it," said Georgianna Bell, executive director of the RLS Foundation.

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

ADVERTISEMENT

Visit this week's sponsor at www.remitdata.com.

About this Newsletter

You are subscribed to this newsletter as #email#

To unsubscribe from this newsletter go to: Unsubscribe

To subscribe to this newsletter, go to: Subscribe

To visit HomeCare's Web site click here

For information on advertising in this newsletter, please contact Kent Peterson, National Sales Manager/Western Region Sales at kpeterson@homecaremag.com, or John McNamara, Regional Sales Manager/Eastern Region Sales at jmcnamara@homecaremag.com.

 
To get this newsletter in a different format (Text or HTML), or to change your e-mail address, please visit your profile page to change your delivery preferences.

For questions concerning delivery of this newsletter, please contact our Customer Service Department at:
Customer Service Department
HomeCare Magazine
A Penton Media publication
US Toll Free: 866-505-7173
International: 847-763-9504
Email:homecaremag@pbinews.com

Penton Media | 249 W. 17th Street | New York, NY 10011

Copyright 2009, Penton Media. All rights reserved. This article is protected by United States copyright and other intellectual property laws and may not be reproduced, rewritten, distributed, re-disseminated, transmitted, displayed, published or broadcast, directly or indirectly, in any medium without the prior written permission of Penton Media.