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| May 18, 2009 | Volume 15, Number 21 |
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ADVERTISEMENT VGM Insurance is your Medicare Bond Expert and is committed to providing: • A simple, 15-minute online process - Minimal amount of information required • Bonds priced below market rate - Extremely competitive prices and several opportunities to receive discounts • Partnerships with Treasury-listed companies Bond Hotline 1-866-497-047  Table of Contents - Rep. Price on HOPP Act: Patient Care + Bureaucrats Don’t Mix - RATC Takes Issue with DME MACs' New Repair Limits - PAOC Meeting June 4 - Part A Trust Fund at ‘End of the Road?’ - Kuhn Appointed to MedPAC - Study Finds Home Health Saves Medicare Billions - Glucose Monitor Checkup; ‘Red Flags’ Rule Delayed; Letter, Survey and Calls to Note - On the HME Calendar For more industry news, features and highlights from our latest issue, please visit our Web site at www.homecaremag.com. Headline News Rep. Price on HOPP Act: Patient Care + Bureaucrats Don’t Mix WASHINGTON--Home oxygen providers got a boost last week when Reps. Tom Price, R-Ga., and Heath Shuler, D-N.C., introduced legislation to repeal the 36-month rental cap on home oxygen therapy--and it couldn’t come at a more critical time. The Home Oxygen Patient Protection (HOPP) Act of 2009 (H.R. 2373), which would restore payments for the period of medical need, was introduced on Tuesday even as the House and the Senate, as well as President Obama, pushed ahead with discussions on how best to reform health care. The president has said he wants to be able to sign reform legislation by the end of the year. Oxygen stakeholders have been working feverishly to get the cap repealed and to establish a platform for an overhaul of Medicare’s oxygen benefit, which they hope can be incorporated into the health care reform package. Price, a physician, told HomeCare Monday that he champions both repeal of the cap and long-term oxygen reform. “The 36-month cap seriously jeopardizes the quality of care that oxygen patients receive by cutting Medicare funding to oxygen providers after the initial three-year coverage period,” Price said. “Oxygen is essentially a prescription drug and should be administered by a trained professional, but [providers] have little incentive to do so, though they’re still required to, since there is no funding in place after 36 months.” Long-term reform of Medicare’s oxygen benefit is vital, he added. “Patients need to know that they can rely on care that meets their needs,” he said. “A system that allows bureaucrats to deny patients essential care is one that needs permanent reform.” Price has twice before introduced legislation to repeal the oxygen cap following the Deficit Reduction Act’s limit on rental payments, which took effect Jan. 1. In Congress’ last session, the HOPP Act (then known as H.R. 621), garnered 143 cosponsors. (See “Price Reintroduces Bill to Repeal O2 Cap,” Jan. 29, 2007.) Shuler has championed the industry’s fight against competitive bidding, calling for an end to the program in a congressional hearing earlier this year. (See “Shuler Calls on Congress to End Competitive Bidding,” Feb. 12.) The revived HOPP Act was introduced just as the Senate Finance Committee began homing in on financing options for health care reform. Those options are expected to be unveiled this week, according to Walt Gorski, vice president of government affairs for the American Association for Homecare. He noted the oxygen benefit could be one of those options. “I think the benefit is still under serious threat for additional cuts, particularly in the Senate,” Gorski said. “We have been working to see that oxygen is not cut as part of those financing options. If it is, it will make reform far more difficult [since] the only place to cut money out of the benefit would, in essence, target the level of service that patients currently receive.” Gorski also said the New Oxygen Coalition, formed earlier this year by AAHomecare, is continuing in its efforts to draft and introduce a long-term oxygen reform package. “That proposal will be forthcoming soon,” he said, adding that he sees the HOPP Act and oxygen reform as “hand-in-glove pieces of legislation.” Meanwhile, if the HOPP Act can spark enough cosponsors, it could help stave off any further cuts, stakeholders said. “My biggest concern is that we get over 220 legislators to sign on,” said Rob Brant, owner of City Medical Services in North Miami Beach, Fla., and president of the Accredited Medical Equipment Providers of America. “We need to hit that number.” Getting a majority of lawmakers as cosponsors in the House of Representatives is needed to assure action on the bill, observers explained. Brant is optimistic, he said, that the industry will have more leverage this time around because the effects of the oxygen cap are being felt by beneficiaries--and they are becoming more vocal about it. “There are many patients who are speaking to their legislators about the problems they are having now that they have capped out,” Brant said. On Friday, he noted, he got a call from an oxygen patient who was having trouble finding a provider to service her oxygen needs when she comes to Florida for an extended stay. Since she was going to cap out in November, providers were telling her she needed to pay out-of-pocket. “Patients are saying it’s not fair that they have to pay up front,” said Brant, adding that he is now advising patients to contact their legislators and urge them to sign onto the HOPP Act. Providers are also encouraging their legislators to back the proposed legislation, according to Teresa Tatum, executive director of the Georgia Association of Medical Equipment Services. GAMES and the North Carolina Associaton of Medical Equipment Services worked with Price and Shuler in developing the new bill. Tatum said she has received numerous phone calls, emails and faxes from providers telling her they were campaigning for support of the bill. “Now it is time for all providers--large and small--to rally together in support of this legislation,” Tatum said. “Washington needs to hear our collective voice as thousands of us make calls and send emails requesting our members of Congress cosign this important legislation.” The sentiment was echoed by a number of HME organizations, including AAHomecare, the National Association of Independent Medical Equipment Suppliers, members services group VGM and the newly formed Committee to Save Independent HME Suppliers (CSI:HME). “All providers are urged to contact their House members and ask that they cosponsor H.R. 2373,” a VGM legislative alert said, noting that Democratic representatives should contact Erin Doty in Rep. Shuler’s office at 202/225-6401; and Republican representatives should contact Emily Henehan in Rep. Price’s office at 202/225-4501. There is an urgency to getting backers’ names on the bill, Gorski said. “Health care reform is unfolding at a lightening pace. We really have never seen things moving as quickly as they are right now,” he said. “This is unprecendented.” For his part, Price believes home care is an answer to the nation’s health care challenges. “Home care allows patients access to care in a more comfortable and more cost-effective setting. What is good for patients is good for health care,” he said. “Home care has to be a part of reform because it provides options to patients,” Price added. “As technology expands, the ability to provide care in different settings will expand as well. The federal government is incapable of providing the responsiveness and flexibility necessary for quality patient care.” The full text of the HOPP Act is available at thomas.loc.gov. 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. RATC Takes Issue with DME MACs' New Repair Limits ARLINGTON, Va.--Saying it threatens the quality of beneficiary care and provider well-being, the American Association for Homecare’s Rehab and Assistive Technology Council called on the DME MAC medical directors last week to withdraw a new wheelchair repair policy. The policy, which went into effect April 1, virtually halves Medicare coverage for wheelchair repair labor and payment, according to the RATC. In comments dated May 11 and signed by AAHomecare President and CEO Tyler Wilson, the organization called the new policy a “radical departure” from traditional Medicare coverage policy for payment of repairs to beneficiary-owned equipment. The latter establishes coverage for repairs up to the cost of replacing the equipment. The new policy, however, affixes a time limit to repairs; providers are prohibited from billing for service in excess of the policy limits. (See "DME MACs Issue Standard Common Repair Allowances," May 2.) According to a table in the new policy, for instance, providers can now bill only two units of service--with each unit representing 15 minutes of labor--to repair or replace a power wheelchair battery, regardless of how long the repair actually takes. The historical average allowable was four units. “The problem we have is with the labor reimbursement,” said Tim Pederson, ATS, president and CEO of WestMed Rehab in Rapid City, S.D., and RATC chair. “It’s an unrealistic cap and a major change in policy. We think they have overstepped their authority.” According to Walt Gorski, AAHomecare vice president of government affairs, “The policy imposes arbitrary restrictions on labor for repairs. There appears to be no basis for these decisions.” He added the restrictions are below providers’ cost, and that imperils quality of care. “Medicare beneficiaries will be adversely affected because [HME] providers cannot afford to perform repairs in the limited time that the DME MACs have determined to be billable,” the RATC said in its comments. “As a result, many HME providers will be unable to provide the needed items and service to Medicare beneficiaries.” The comments also questioned the MACs’ assertion that the new policy is a payment policy. It cannot be so, the RATC argued, “because the policy does not in reality establish the ‘fee’ for labor. Rather, it imposes a frequency limitation on coverage for this service. Consequently, we believe that the DME MACs have confused a payment determination with what is in fact a coverage determination.” The RATC pointed out that CMS has already addressed coverage for repairs, as well as established the payment methodology and the payment amount. “Any additional action by the DME MACs with respect to establishing reimbursement for labor is unnecessary,” the Council maintained. Beyond that, the policy is “procedurally defective and must be withdrawn,” the RATC said, because there was no notice and no opportunity for comment. “The DME MACs can do payment policy, but they cannot do coverage determination as they did it without notice and comment,” said Gorski. By not getting input, the RATC said, the DME MACs imposed unrealistic time limitations on providers. “The DME MACs imposed frequency limits on Medicare coverage for labor without any consultation with providers. As a result, the new policy grossly underestimates the time involved in making a repair,” the comments note. “We request that the DME MACs withdraw the policy and adhere to the repair policy specified under the [Medicare benefit and claims processing] manuals.” Should the MACs elect not to rescind the policy, the association said they should at least withdraw the policy and issue a proposed policy with an appropriate comment period. “These are very concerning and distressing changes,” Gorski said. “This is a quality-of-care issue, a beneficiary issue. It’s the beneficiaries who suffer. We hope to change the minds of the medical directors in order to have this policy changed.” PAOC Meeting June 4 BALTIMORE--CMS has announced the June 4 meeting of its new Program Advisory and Oversight Committee to discuss the Round One rebid of competitive bidding is open for public registration. According to a CMS notice: “The agenda will focus on legislative changes mandated by the Medicare Improvements for Patients and Providers Act of 2008 as well as additional process improvements. CMS expects that the feedback received from the PAOC committee members and the pubic will assist the agency as it moves forward with the Round One rebid.” The meeting will be held at the BWI Airport Marriott in Baltimore from 8:30 a.m. to 5 p.m. Because a large number of attendees are expected, seating will be on a first-come, first-served basis. Get information and register online at http://www2.blsdev.com/blsmeetings/h1565. Registrations must be received no later than 5 p.m. EDT May 29. Part A Trust Fund at ‘End of the Road?’ WASHINGTON--Medicare's Part A hospital trust fund assets will run out in 2017, two years earlier than previously projected, according to a May 12 report from the program's trustees. According to the report, the new date reflects lower projected payroll tax income as a result of the recession. Total income to the trust fund in 2009 is estimated to fall short of expenditures by $20 billion. Total Medicare expenditures were $468 billion in 2008 and are expected to increase in future years at a faster pace than either workers’ earnings or the economy overall, the report said. As a percentage of GDP, expenditures are projected to increase from 3.2 percent in 2008 to 11.4 percent by 2083. What’s more, bringing the massive program back into actuarial balance over the next 75 years would take a 134 percent increase in the payroll tax or a 53 percent reduction in outlays, or a combination of those measures. The report found that Medicare Part B (including physicians and HME) and Part D (prescription drugs) are projected to remain adequately funded indefinitely because current law requires financing to meet projected costs. “Such financing, however, would have to increase rapidly to match expected expenditure growth under current law,” the trustees said. According to Obama administration officials, rapidly rising health care costs are the cause of Medicare’s financial woes and illustrate the need for comprehensive health reform legislation. HHS Secretary Kathleen Sebelius stressed reform at a briefing covering the report. “We think Medicare can be an innovator and actually lead the way on changing the cost projections which are crushing businesses, governments and families,” she said. Senate Finance Committee Chairman Max Baucus, D-Mont., said the report illustrates the connection between an economic recovery and Medicare reform. “There is a direct connection between the rising cost of health care and the long-term stability of the Medicare program, and this report underscores the urgency of action on comprehensive health care reform this year,” Baucus said in a statement. But Sen. Charles Grassley, R-Iowa, the committee’s ranking member, summed up the situation a bit more succinctly. The “message of the trustees' report is loud and clear,” he said. “We need to act now to address Medicare's fiscal sustainability. Kicking the can down the road isn't an option anymore because we're at the end of the road.” Read the full report at: www.cms.hhs.gov/ReportsTrustFunds/downloads/tr2009.pdf. Kuhn Appointed to MedPAC WASHINGTON--The influential Medicare Payment Advisory Commission has appointed two new members, including Herb Kuhn, former deputy administrator of CMS. Acting Comptroller General Gene Dodaro announced Kuhn’s appointment May 8, along with that of Robert A. Berenson, a senior fellow at the Urban Institute. The Comptroller General is responsible for naming new members to the commission, an independent 17-member federal body that advises Congress on Medicare issues. An independent health care consultant, Kuhn was CMS deputy administrator under President George W. Bush until earlier this year, and served as director of the Center for Medicare Management at CMS from 2004 to 2006. He will complete the remaining year of former MedPAC member Jack Ebeler's three-year term, which began in 2007. Ebeler resigned in March. Speaking at the American Association for Homecare’s Legislative Conference in 2007, Kuhn, then at CMS, said the agency was looking for value in the dollars it spends. That meant focusing on prevention, pay for reporting, pay for performance, transparency, cost-effectiveness--“and yes, it also means competitive bidding,” he told attendees. Berenson was director of the Center for Health Plans and Providers with CMS' predecessor, the Health Care Financing Administration, during the Clinton administration. He was appointed to a three-year term that runs through 2012. Study Finds Home Health Saves Medicare Billions WASHINGTON--Patients with at least one chronic disease who used home health care after hospitalization saved Medicare $1.7 billion over a two-year period, according to a study released May 11. The study, conducted by health care research company Avalere Health, found that Medicare beneficiaries with diabetes, COPD or congestive heart failure who used home health care within three months of being discharged from a hospital cost the program $1.71 billion less than similar patients who used other forms of post-acute care. In addition, they had 24,000 fewer rehospitalizations during the 2005-2006 study period. The report concluded that if all of the chronic care patients had used home health services early during post-hospital care, Medicare could have saved an additional $1.77 billion over the two-year timeframe. The study was funded by the Alliance for Home Health Quality and Innovation, but Avalere said it maintained sole discretion with regard to study methods and interpretation of findings. Significantly, 86 percent of people who qualify for Medicare have at least one chronic condition and 40 percent have three or more, Avalere said. But only 8.9 percent of Medicare beneficiaries currently use home health services, a fact attributed in large part to the program’s requirement that an individual be “homebound” and unable to leave the home without significant assistance in order to receive the benefit. “Given the size of the chronic care Medicare population, any serious effort to improve cost-effectiveness of Medicare benefits will have to grapple with these patients,” said Avalere Director Alexis Ahlstrom, adding that “additional research should be done to determine the impact of home health on non-chronic care patients.” In a statement, AHHQI said it believes the unrealized savings identified in the study could allow Medicare to save $31.1 billion over the next 10 years by expanding access to home health for chronic disease patients. Read the complete report, titled "Medicare Spending and Rehospitalization for Chronically Ill Medicare Beneficiaries: Home Health Use Compared to Other Post-Acute Care Settings." In Brief Glucose Monitor Checkup; ‘Red Flags’ Rule Delayed; Letter, Survey and Calls to Note Last week, CMS issued a new MLN Matters article on training Medicare patients on the use of home glucose monitors and related billing information. The Jurisdiction A DME MAC has also added a new “Test Your Knowledge” quiz on the glucose monitors LCD. Take the quiz on the NHIC Web site. ‘Red Flags’ Rule Delayed For the second time, the Federal Trade Commission has delayed enforcement of its new “Red Flags” rules requiring the implementation of identity theft prevention programs. The rules had been set for enforcement May 1, but in a last-minute decision, the commission pushed back its compliance deadline to Aug. 1. For more about the rules, see “Are You Ready for the Red Flags Rule?” ITEM Letter Asks for Cushion Bid Exemption The Independence Through Enhancement of Medicare and Medicaid (ITEM) Coalition, a consumer-led group of more than 70 seventy disability, aging, health and provider associations, has asked HHS to take wheelchair seating cushions out of competitive bidding. In a letter to HHS Secretary Kathleen Sebelius, the coalition pointed out that such specialized cushions must be specifically fitted to users. If the cushions are bid, the group said, some providers could move to low-cost cushions, and that could have consequences for beneficiaries. While CMS has said privately it would consider such a request prior to Round Two, under the Medicare Improvements for Patients and Providers Act, the agency is prohibited from changing the codes that are to be rebid in Round One. According to one insider, however, some in the clinical and end-user communities are urging CMS to review and revise the list of codes before moving forward with the DMEPOS bidding program.
CSI:HME Wants to Know
Among the survey's questions: Do you support passage of H.R. 2373 to repeal the 36-month cap on home oxygen payments? Do you support an oxygen reform plan that removes home oxygen from the DMEPOS benefit into a separate provider status category? CSI:HME said more specific surveys in the coming weeks will be used to gather details on topics including the effects of the oxygen cap on patients, DMEPOS reform, competitive bidding and fraud. The current survey is available at http://FreeOnlineSurveys.com/rendersurvey.asp?sid=1ou56qsdhtk1sfd587984.
CMS to Reschedule Open Door Forum
CMS' Brandt Meets with AAHomecare
NAIMES Marks Second Year New HHS Office of Health Reform
Jurisdiction C Offers Modifier Finder Tool Coming Up On the HME Calendar The American Association for Homecare will hold its annual Legislative Conference June 1-3 in Washington, D.C. Call 703/836-6263 or visit www.aahomecare.org for more information. The Associated Professional Sleep Societies’ (APSS) SLEEP 2009 will be held in Seattle June 6-11. For more information, call 708/492-0930 or visit www.apss.org. VGM Group's Heartland Conference is set June 8-11 in Waterloo, Iowa. Call 800/642-6065 or visit www.vgm.com for more information. The American Physical Therapy Association (APTA) will hold its PT 2009 conference and exhibition June 10-13 in Baltimore. For more information, call 800/999-2782 or visit www.apta.org. Sponsored by the Alabama Durable Medical Equipment Association (ADMEA), the Southeastern HME Convention will run June 14-16 in Orange Beach, Ala. The group is expecting attendees from Alabama, Georgia, Florida, Mississippi, Tennessee and Louisiana. Call 205/824-6202 or visit www.admea.net. The Rehabilitation Engineering and Assistive Technology Society of North America (RESNA) has set its Annual Conference June 23-27 in New Orleans. For more on the conference, call 703/524-6686 or visit www.resna.org. The New England Medical Equipment Dealers Association (NEMED) will hold its 21st Annual Meeting June 24-26 in Hyannis, Mass. For more information, call 508/993-0700 or visit www.nemed.org. In observation of Memorial Day, HomeCare Monday will resume publication June 1. As we remember those men and women who have died in military service to our country and those who serve the United States today, the staff of HomeCare wishes you and yours a safe holiday. ADVERTISEMENT |
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