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Headline News
CMS Releases 64 New Power Mobility Codes
BALTIMORE--Just a few minutes before 5 p.m. on Friday, CMS announced that it had posted information about the new HCPCS codes to be used for power wheelchairs beginning Oct. 1.

Under the new coding structure, there are six groups of power mobility devices with a total of 61 codes that separate the products based on functionality and levels of performance. Each group has sub-divisions based on weight capacity and/or powered seating system capability. The 61 codes include not only the type of power wheelchair base but also the options and accessories that come standard with the chairs. Three additional "miscellaneous" codes cover PWCs and power operated vehicles not otherwise classified, and PMDs not coded by the SADMERC or that don't meet criteria.

"It is CMS' belief that the changes made to the coding sets will provide physicians and other practitioners with a wide range of choices that will allow beneficiaries to be placed in the most appropriate chair," the agency said.

This is the third time the codes have been reworked within the past two years (see HomeCare Monday, Oct. 24, 2005). This most recent effort resulted from the work of a 14-member technical expert panel--consisting of suppliers, manufacturers, testing facilities, rehabilitation engineers and clinicians--and the SADMERC.

Although new mobility codes were originally scheduled to take effect Jan. 1 this year, CMS announced in October that it would delay implementation in order to rework the codes with the panel's input. The goal was to "more accurately reflect the range of PMDs currently on the market, allow for more accurate payment and ... establish testing standards to ensure only quality products are provided to Medicare beneficiaries."

Last fall, SADMERC Director Dr. Doran Edwards even announced that he had suspended all other duties to devote time to the coding project to "get it right."

"Codes resulting from this collaborative effort allow placement of individual devices into performance-based categories and tie those categories to distinct patient populations," the SADMERC said. "The resulting interplay of codes and clinical applications allows for a policy reflective of actual practice in PMD selection. Downcoding and claims denial will be reduced because proper device/patient selection will be more evident."

Current PWC codes have been in use since 1993 and the one code for POVs has been in use since 1986, but subsequent innovation in the field created a need to expand both the number of categories and the number of codes, CMS explained.

The SADMERC noted this set of codes is an interim step to allow implementation, and that a set of "K" codes to be used for billing will be developed by the Alpha Numeric Work Group before Oct. 1.

The SADMERC also said a revised set of test parameters to accommodate future technological advances will be published soon. In the meantime, all PMDs will have to be retested according to the expanded criteria. "Policy and pricing changes will also be made as needed," the SADMERC said.

Based on feedback from the expert panel, the agency said CMS and the SADMERC also have instituted some additional tests to those already required under the previous code set to reflect "the variety of performance and durability challenges the PMDs may undergo during the course of a five-year lifetime." A subset of current Rehabilitation Engineering & Assistive Technology Society of North America (RESNA) standards for PMDs, the new tests include:

• Speed fall-off for slope at maximum speed;
• Static strength on foot rests;
• Impact strength on foot rests;
• Climatic test (rain test);
• Power and control systems;
• Static stability and dynamic stability; and
• Power off emergency brake test.

To view the new codes, visit the SADMERC Web site by clicking here, then follow the instructions.

Bill Proposes to Strike Oxygen Provision from DRA
WASHINGTON--In response to patient safety issues raised by the American Association for Homecare, the American Lung Association and other advocates, a bill introduced late last month in the House of Representatives would do away with the Deficit Reduction Act's mandate for oxygen capped rental.

The Home Oxygen Patient Protection Act, introduced by Rep. Joe Schwarz, R-Mich., a physician, calls for repeal of a DRA provision that limits rental of all home oxygen equipment to 36 months then transfers ownership to the beneficiary, changing oxygen from a continuous rental to a rent-to-purchase item (see HomeCare Monday, Jan. 9).

Providers and other stakeholders have argued that the new policy could put patients, many elderly and frail seniors, in danger if they are responsible for upkeep and maintenance of oxygen equipment--a service many companies currently provide as part of the rental fee.

"This bill can help a million Americans to breathe easier," said AAHomecare Chairman Tom Ryan. "The association is grateful to Congressman Schwarz and the co-sponsors for their leadership and understanding of the importance of medical oxygen therapy provided at home."

Co-sponsors of the bill include another physician, Rep. Tom Price, R-Ga., as well as four Ohio congressmen: Reps. Ralph Regula, Patrick Tiberi, David Hobson and Tim Ryan.

According to AAHomecare, medical oxygen therapy at home costs an average of $2,400 per year under Medicare, about half the cost of an average single day in the hospital.

To view the text of H.R. 5513, visit http://thomas.loc.gov.

Mobility Products to Pay $2.8 Million to Settle Fraud Allegations
TAMPA, Fla.--Mobility Products Unlimited will pay $2.78 million to resolve civil fraud allegations, federal prosecutors announced May 25.

The settlement ends a government investigation into whether the South Daytona, Fla.-based provider improperly billed Medicare for used wheelchairs and scooters as if they were new, according to the office of U.S. Attorney Paul Perez with the Middle District of Florida.

The government also alleged that MPU billed separately for unbundled wheelchair and scooter accessories (mainly seatbelts and adjustable-height armrests) and offered Medicare beneficiaries manual wheelchairs for free or at a drastically reduced price in order to secure the sale of a power chair, the attorney's office said.

In addition to the payment, MPU and its owner, John Ward, entered into a five-year corporate integrity agreement, according to the attorney's office. The deal requires MPU to hire an independent organization to conduct a comprehensive claims review, including determination of medical necessity.

MPU--the country's second largest power wheelchair and scooter provider, according to officials--advertises heavily on TV. In a statement, the company acknowledged no wrongdoing and noted that Ward became CEO in July 2005. The investigation covered a period from January 1999 through May 2005.

"We are pleased to have resolved these complex matters by working closely with the government. Mobility Products Unlimited fully cooperated with the government during the course of their one-and-a-half year inquiry, and I believe that it is in the best interest of the company to put these prior period matters behind us," Ward said in the statement.

The settlement agreement was reached with the U.S. Attorney's Office for the Middle District of Florida, the Department of Justice, Civil Division, and the HHS Office of Inspector General.

Few New Competitive Bidding Details at Two-Day PAOC Meeting
BALTIMORE--CMS held a Program Advisory and Oversight Committee meeting last month to give an overview of its Notice of Proposed Rulemaking on DME competitive bidding, but committee members said most of their questions about the proposed rule remain unanswered.

The May 22-23 meeting was the first for the panel--charged with the task of advising CMS on implementing Medicare DMEPOS competitive bidding--since CMS issued its draft proposal on the program last month (see HomeCare Monday, May 1).

But PAOC member Cara Bachenheimer said CMS didn't divulge much new information that couldn't already be found in the draft rule.

"It was kind of a frustrating couple of days," said Bachenheimer, vice president, government relations, for Elyria, Ohio-based Invacare Corp. "People are so hungry for answers to their questions, but they just don't exist at this time. CMS' approach is that the regulation provides a broad framework, and many of the details will be in subsequent documents that they will issue after the final rule comes out."

According to a summary from the American Association for Homecare, the following are among key issues that were covered:

--Quality Standards and Accreditation: More than 5,600 stakeholders commented on the draft supplier quality standards, which were released last November, with the most common complaint that they were "too prescriptive," CMS said. Agency officials agreed and said they are working to adjust the standards. In one clarification of another common complaint--that responding to a beneficiary call within 60 minutes is unrealistic--CMS said it did not intend to suggest that providers had to arrive at a patient's home within 60 minutes and would clarify this point or change the wording.

Officials said they are also considering a number of comments on the business standards in the draft, including the concern that they are overly burdensome and that some of the standards should be left to state and local laws.

But officials said they could not comment about a number of other topics involving supplier standards and accreditation, including whether providers in areas selected for the first round of bidding could be grandfathered in if they are already accredited. The agency said it would provide further guidance on the question and announce solicitation of accreditation organization applications after the final rule has been published. CMS did say it would phase in the accreditation process, and would require accrediting organizations to prioritize their surveys to accredit providers in the initial 10 cities where the bidding program is scheduled to begin.

--Rebates: The rebate provision in the proposed rule drew opposition from several PAOC members, who cited concerns about legal and administrative issues. Under the rebate program, providers who submit a bid below the single payment amount that is set would be allowed to offer a rebate to beneficiaries equal to the difference between their actual bid and the payment amount. CMS said the rebates would allow providers to be more competitive. But PAOC member Dave Kazynski, president of VGM's Homelink, noted that beneficiaries are mainly concerned about quality, not a small rebate. Home care providers "are not looking at market share, they're looking at survival," he said.

--Sustainability: Several PAOC members also said they are worried that unrealistically low bids would distort the process. "There is no provision in the methodology to determine whether the winning amount is sustainable," said attorney Asela Cuervo, who represents AAHomecare on the committee.

Committee members said other issues of concern include the criteria for selecting cities and products for the bid; the bidding process and winning bidder selection; how payment amounts will be set; the absence of small supplier protections; the requirement that a supplier would have to bid on an entire product category; and how a mail order bid would impact the process.

However, Bachenheimer pointed out that the PAOC's role is advisory only. "CMS can hear our opinions but there's nothing that forces CMS to adopt them or even to explain why they reject specific recommendations from the PAOC," she said.

CMS is expected to release the final quality standards this month, and the target date for release of the final competitive bidding rule is October this year.

CMS said its estimates were based on its competitive bidding demonstrations in San Antonio, Texas, and Polk County, Fla.

Competitive Bidding
Each week before comments are due to CMS June 30, HomeCare Monday will examine a specific segment of the recently released proposed rule on DME competitive bidding (see HomeCare Monday, May 1). This week we look at small supplier issues.

Issues: "The proposed rule really does not provide any special protections to guarantee small supplier participation in the competitive bidding program," said Seth Johnson, director of government affairs for Exeter, Pa.-based Pride Mobility. "The only real difference in criteria for small suppliers versus other suppliers is under the 'Financial Information' section on the draft application form to participate in the competitive bidding program."

Small providers are required to submit reviewed financial reports--balance sheets, income statements and cash flow statements--by an outside, independent, certified public accountant, he said.

"According to the proposal, this review is less in scope than an audited financial statement and does not have an 'opinion' regarding the financial statement," he noted, explaining that all suppliers not meeting the definition of small business--those with less than $6 million in annual receipts--would be required to submit audited financials with their application.

Although not specific to small providers, the proposal would allow suppliers to form networks with others and enter into subcontract arrangements, which could benefit smaller businesses.

CMS also proposes allowing providers to bid by product category to enable small businesses and others who specialize in one segment of the industry or another to retain the ability to bid.

"The problem is many suppliers specialize in one area within a product category and do not provide the full range of products, services and accessories within the product category," Johnson said. "At least a few of the current product categories include multiple medical policies and extremely different levels of technology. While CMS will establish unique product categories for the purposes of competitive bidding by HCPCS code, it is unclear what individual HCPCS codes will be included in the new product categories."

This information will be included in the Request for Bid document to be released following CMS' publication of the final rule.

Another major concern, Johnson said, is that small suppliers are required under the proposed rule to provide products and services for any winning bid throughout the entire bid area, not just in their current geographic business area.

"CMS considered allowing small suppliers to bid by zip code within the [metropolitan statistical area]. However, this was rejected because CMS thought this would lead to 'cherry picking' the best markets within the MSA," he explained.

What suppliers need to know: "Another issue that needs to be factored into the equation when providing comments on the proposed rule is the final quality standards and what impact they will have on small suppliers," Johnson said. "While final quality standards are expected in June, suppliers will need time to review the final standards ... well in advance of the close of the comment period on the proposed competitive bidding rule (June 30), so [their] comments can reflect the impact of the final quality standards."

Coming Up
America's Health Insurance Plans (AHIP) will hold its Annual Institute in San Diego June 7-9. For more information, call (877) 291-2247 or visit www.ahip.org/links/institute2006.

Healthcare Distribution Management Association (HDMA) will hold its Distribution Management Conference & Technology Expo in Phoenix June 7-10. For more information, call (703) 885-0280 or visit www.healthcaredistribution.org.

VGM will hold its Heartland Conference in Waterloo, Iowa, June 12-15. The conference will feature more than 60 speakers presenting nearly 90 classes in eight tracks: regulatory, sales and marketing, products and technology, operations, executive, respiratory, rehab and reimbursement. For more information, call (800) 642-6065 or visit www.heartland2006.com.

The Case Management Society of America will hold its Annual Conference & Expo in Gaylord, Texas, June 13-17. For more information, call (501) 225-2229 or visit www.cmsa.org.

Associated Professional Sleep Societies (APSS) will hold its 20th Annual Meeting in Salt Lake City June 17-22. For more information, call (708) 492-0930 or visit www.apss.org.

The Tri-State HME Convention (Alabama Georgia and Mississippi associations) will be held in Orange Beach, Ala., June 18-20. For more information, call (866) 808-2022 or visit www.gameshme.org.

The American Association for Homecare will hold its Legislative Fly-In in Washington, D.C., June 19-20. This year, the annual lobbying event will include an oxygen technology fair so that members of Congress and their staffs can see in person how oxygen patients use their equipment and view some of the current oxygen technologies. For more information, call (703) 836-6263 or visit www.aahomecare.org.

The New England Medical Equipment Dealers Association (NEMED) will hold its annual conference in Groton, Conn., June 19-21. For more information, call (508) 993-0700 or visit www.nemed.org.

The American Physical Therapy Association (APTA) will hold its annual conference and expo June 21-24 in Orlando, Fla. For more information, call (800) 999-2782 or visit www.apta.org.

The North Carolina Association for Medical Equipment Services (NCAMES) will hold its Summer Meeting and Exhibit in Wrightsville Beach, N.C., June 22-24. For more information, call (919) 387-1221 or visit www.ncames.org.

Rehabilitation Engineering & Assistive Technology Society of North America (RESNA) will hold its annual conference in Atlanta June 22-26. For more information, call (703) 524-6686 or visit www.resna.org.