The letters and a list of House cosignatories are posted on the AAHomecare Web site at www.aahomecare.org.

CMS Plans Beneficiary Outreach, Will Host Third Provider Training Call
BALTIMORE--With only three weeks until the implementation of round one July 1, CMS said Friday it will announce an outreach effort on competitive bidding aimed at beneficiaries.

In a media advisory sent Friday afternoon, the agency said acting CMS Administrator Kerry Weems will hold a news briefing this afternoon to announce “Medicare’s outreach effort to help beneficiaries learn about a new program that lowers costs for DME under the competitive bidding program.”

On a call for beneficiary advocacy groups in early May, CMS officials said beneficiaries in the 10 round one CBAs would receive a mailing about Medicare’s impending changes with a list of contract suppliers and a program brochure. In a provider training call May 27, agency representatives repeated there would be a mailing to beneficiaries in the bid areas, but advised providers themselves to notify their Medicare patients about grandfathering decisions by June 1. Since, providers have been rushing to get those notices out. (See “Frustration Over ZIP Codes Spreads to Round One” in this issue.)

CMS has also planned a conference call for referral agents and non-contract suppliers to address additional questions on competitive bidding. The call will be held June 12 from 1 p.m. to 2:30 p.m. EDT.

Participants will be able to submit questions through the online registration system at the time of sign up for the call. To register, go to www2.eventsvc.com/palmettogba/061208. Registration must be completed by 1 p.m. June 11.

After the call, a replay will be accessible from 3 p.m. June 12 until 11:59 p.m. June 17. The number for the replay is 800/642-1687 and the passcode is 49895703.

Last week, the agency did release a flurry of new educational aids for providers on how things will work post-July 1, among them:

--a tip sheet for physicians and other treating practitioners that outlines exceptions under which they can provide certain types of bid items in a CBA to their own patients without being selected as a contract supplier.

--a tip sheet for non-contract suppliers that includes circumstances under which they can bill for bid items and the actions they need to take to assure continuity of care for their patients living in the CBAs. The tip sheet covers CMS’ recommendation that non-contract suppliers who decide not to become grandfathered suppliers for oxygen and oxygen equipment notify their Medicare patients 30 days in advance of the July 1 start date “so that beneficiaries have adequate time to transition to contract suppliers and not risk gaps in critical services.” The tip sheet also gives information about picking up equipment and the need for coordination with contract suppliers so that new equipment is delivered before old equipment is removed.

--a tip sheet for mail order contract diabetic suppliers that explains how this part of the program works. Under competitive bidding, beneficiaries who live in or travel to the 10 round one CBAs must obtain diabetic testing supplies from a contract supplier unless an exception applies.

--a special edition MLN Matters article (SE0820) titled “Marketing Rules Reminders for DME Suppliers Including Contract Suppliers under the DMEPOS Competitive Bidding Program” that describes the existing marketing rules and prohibitions that apply to all Medicare DMEPOS suppliers.

--a companion MLN Matters article (MM5978) that accompanies the first of several installments in the new Chapter 36 of the Medicare Claims Processing Manual about policies and instructions under competitive bidding, including when non-contract suppliers should obtain a signed Advance Beneficiary Notice.

--the transcript from a May 13 conference call on competitive bidding that includes an overview of the program and a Q&A session with participants. To access the transcript, go to the CMS competitive bidding Web site at www.cms.hhs.gov/DMEPOSCompetitivebid, then click on the “Announcements and Communications” tab and scroll down to the “Downloads” section.

The tip sheets and MLN Matters articles are also available on the CMS Web site at www.cms.hhs.gov/DMEPOSCompetitivebid. Click on the “Provider Educational Products and Resources” tab and scroll down to the “Downloads” section.

Additionally, Jurisdiction B DME MAC National Government Services said last week it will host two Ask-the-Contractor teleconferences June 19 to discuss competitive bidding. A morning session will be held from 10 a.m. to 11:30 a.m. ET, followed by an afternoon session from 2 p.m. to 3:30 p.m.

The call will include an overview of competitive bidding as well as information on new modifiers, important dates and reminders and where to find educational resources. A PowerPoint presentation will be posted to the NGS Web site prior to the call. After the presentation, there will be a question-and-answer session.

The call is free, but registration is required at www.ngsmedicare.com/ngsmedicare/DMEMAC/EducationandSupport/CalendarofEvents/Registration/cal_dme/contentindex_cal_dme.cfm.

Frustration Over ZIP Codes Spreads to Round One
ATLANTA--With only days left before the implementation of competitive bidding in 10 of the country's largest metropolitan areas, last week some HME providers said they were stumped about ZIP codes--but not about those in round two, the ZIP codes in round one.

Not knowing the ZIP codes that will define the next 70 competitive bidding areas has been one of the industry's main questions since the round two MSAs were announced Jan. 8.

But the focus quickly shifted to round one last week when a number of providers--working to notify patients of the Medicare changes coming July 1--thought the agency had added ZIP codes to the original bidding area list.

In a message Thursday, the Midwest Association of Medical Equipment Suppliers said Sheila Showalter-Roberson from Criticare Home Health Services in Lawrence, Kan., was working on her company's grandfathering letters and noticed 37 “new” ZIP codes on the list for the Kansas City CBA. And Gerald Sloan of Progressive Medical Equipment, Lenexa, Kan., found that after matching the ZIP codes to counties, a majority were outside the original MSA, not just the CBA.

Other providers also notified the American Association for Homecare that a CBIC file outlining the CBAs appeared to include additional ZIP codes, said Walt Gorski, vice president, government relations.

But, Gorski said, CMS assured the association that “no new ZIP codes were added.”

What happened, he said, is that the CBIC commingled the ZIP codes for mail order and non-mail order items into one master file.

In that file, said MAMES Executive Director Rose Schafhauser, “there is no way to distinguish if there truly are just certain zip codes for diabetic supplies versus all of the other product categories included in competitive bidding. It's not clear on the CBIC Web site if there are two different lists, and they are expecting suppliers to be compliant with the grandfather letter. But how are they supposed to be doing that?”

According to Gorski, “Suppliers had every reason to be concerned because there is no distinction between mail order and non-mail order in that master file.”

In an update on its Web site Friday, the CBIC said two ZIP code files--one with mail order ZIP codes and one with non-mail order ZIP codes for each of the round one CBAs--would be posted “in the near future.”

Until the new files are available, however, providers were advised to use the "Find a CBA" tool on the home page of the CBIC Web site to access lists of mail order and non-mail order ZIP codes.

“We consider this a very serious issue, especially since there are only 16 business days left before implementation,” Gorski said. “It's very confusing.

“While we are pleased that CMS is clarifying this issue, we are still extremely concerned that suppliers may have incorrectly notified patients that they must now find a new supplier. This is just another example of the hasty rush to implement the program rather than ensure that it is done in a proper manner.”

“We've only got so many days left,” added Schafhauser. “Providers are really scrambling trying to get notification out to their customers, and this makes it worse.

“It's just another thing to shake your head at,” she said.

To view mail order and non-mail order ZIP codes for each round one CBA, click here.

Next, use the “Competitive Bid Areas” link on the left side of the page, then “Select a state/territory” and “Select a CBA.” ZIP codes for non-mail order items are listed under the “CBA” link.

AMEPA Rallies Providers on Streets of Florida, Texas
AMEPA Rallies Providers on Streets of Florida, Texas MIAMI--Home medical equipment providers working frantically to stall the implementation of round one of competitive bidding took their efforts to the streets in Florida last week, waving placards and handing out flyers to passersby in hopes of drumming up more support.

Two more rallies are planned, one today in downtown Orlando, and one on Tuesday in Dallas, according to Rob Brant, president of the Accredited Medical Equipment Providers of America, which sponsored the rallies.

News of the rallies--and the industry’s side of the competitive bidding story--appeared on the front of the business sections of both the Miami Herald and the Sun-Sentinel.

“No experience + no license + no office = bid winner” proclaimed a placard in a photo accompanying the Sun-Sentinel story.

Brant said he was pleased at the support for the rallies so far. More than 100 providers showed up for Thursday’s rally in front of the Department of Health and Human Services office Miami, he said. AMEPA’s rally permit allowed for only 30 people at a time, however, so providers had to alternate. Still, “we had so many people in Miami that we had all four corners of the intersection covered.”

Other rallies in Fort Lauderdale and Palm Beach were also well supported, he said.

AMEPA decided to sponsor the rallies, Brant said, after the American Association for Homecare’s May 21 legislative fly-in. Some 160 providers descended on Capitol Hill to meet with legislators about competitive bidding and urge them to delay its implementation.

“After the Washington fly-in, we just figured every congressman would be on board around the state,” Brant said.

But in a discussion with an aide to Sen. Bill Nelson, D-Fla., Brant found that was not the case. Indeed, neither of Florida’s senators supported a delay.

“Nelson’s health care aide said that if CMS said everything is fine, then everything is fine,” Brant said. “We were appalled by that. We were really frustrated they weren’t listening to us. So now we’re making them listen to us, which is basically why we are doing the rallies.”

The flyers, he said, advise people to call Nelson and Florida’s other senator, Republican Mel Martinez. “They need to hear from their constituents to stop this,” Brant said.

Next PAOC Meet Set June 16
BALTIMORE--Last week, CMS announced the first meeting of the Program Advisory and Oversight Committee since October of 2007 (see HomeCare Monday, Oct. 15, 2007).

The meeting, which will be held June 16 from 9 a.m. to 5 p.m. at the Pikesville Hilton Hotel in Pikesville, Md., is “to discuss the first round of bidding for the Medicare DMEPOS competitive bidding program,” according to CMS.

In its announcement, CMS said, “The agenda is focused on progress on implementing the first round of the competitive bidding program. CMS hopes that the feedback we receive from the PAOC committee members and the public will assist us as we move forward with the next round of competitive bidding.”

The meeting schedule includes an update on rounds one and two along with sessions on the contract award process; education, outreach and monitoring; and an accreditation and quality standards update. Time for public comments has been allotted from 4 to 5 p.m.

For more information or to register for the meeting, click here. Registration must be received by June 12. Attendees who would like to speak during the meeting can sign in at the registration desk.

NCB Not the Only Battleground, State Leaders Say
ATLANTA--While the industry’s providers are fighting for their very lives as CMS prepares to implement national competitive bidding July 1, thousands are also having to fend off threats at home, such as Medicaid cuts and state taxes on HME.

Referring to impending cuts in his state, said Bob Achermann, executive director of the California Association for Medical Product Suppliers, “We’ve weathered through before, but this may be the worst.”

Here are only a few issues some state associations are grappling with:

--CAMPS: Prompted by a $17 billion budget shortfall--the size of some smaller states’ entire annual budgets--California legislators have decreed a 10 percent Medicaid reimbursement cut to take effect July 1. On May 30, the state Senate voted to reduce the cut to 5 percent; the state Assembly eliminated it altogether. But for either alternative to supercede the 10 percent cut, it must be part of the final state budget, which could be months away. That means the 10 percent reduction is likely to take effect.

“The budget news is very bad,” said Achermann, noting that not only does the 10 percent cut loom, so does a budget impasse.

“The health care deposit fund is what pays [Medi-Cal] claims, and that money will get burned through by some time in July,” he explained, adding that while a new budget is due June 15, California legislators have a history of not passing a new budget on time. “So there are general cash-flow issues of not having money to pay Medicaid claims anyway.”

The June and August Medi-Cal payments are already scheduled to be delayed; with the budget on hold, providers may likely need to wait until September for another payment. “All that risk puts everybody in jeopardy of not being paid at all. It’s all about moving money from one fiscal year into the next,” Achermann said.

There is an upside, however, he said. “The good news is that there is a federal lawsuit filed in Los Angeles Superior Court that would enjoin the 10 percent cut.”

The lawsuit, filed in May by the Alliance for Patient Choice, a coalition of more than 100 health organizations, seeks an injunction against the planned reimbursement cut on the grounds that it violates “state and federal laws that require that Medicaid (Medi-Cal) payments "must be sufficient to enlist enough providers so that services under the [state’s Medicaid] plan are available to recipients at least to the extent that those services are available to the general public.”

At press time, no hearing had been set.

--GAMES: After investing months of concentrated effort, the Georgia Association of Medical Equipment Services was finally successful in getting medical equipment that is not currently covered under the regulation (such as ventilators and sleep equipment) exempt from state sales tax. Currently, patients pay the tax.

H.B. 1078, a sales and use tax bill, was signed into law in May. It will become effective July 1.

--MAMES: The Midwest Association of Medical Equipment Services is dealing with pockets of problems among some of its member states, which include Iowa, Kansas, Minnesota, Missouri, Nebraska, North Dakota and South Dakota.

“One of the big issues in South Dakota is that Medicaid has been denying all claims with [national provider identification] numbers,” said Rose Schafhauser, executive director. While CMS is requiring that all claims include the NPI only, the state program is apparently not recognizing it, she said.

“It’s a huge cash drain on providers in South Dakota,” Schafhauser said.

In Minnesota, a new law regarding paper simplification “will dramatically impact organizations that bill the state,” Schafhauser said. Currently, she noted, if an HME product has no HCPCS code, one will be developed that can only be used by Minnesota providers.

“But that goes away next year and they will have to have standard codes,” she said. She has hopes that providers will be able to sidestep any fiscal impacts; MAMES is represented on the committee to address the issue.

--PAMES: For the ninth year in a row, the Pacific Association for Medical Equipment Services, which covers Washington and Oregon, is back in the battle to get HME exempt from Washington’s sales tax.

“We have made eight attempts over eight years and four bills, and we have failed to get it through the House Rules Committee eight times,” said Tom Coogan, president of PAMES and director of industry affairs for Care Medical, Portland, Ore.

After more than 100 legislative visits to the state House and Senate so far this year, support is building for the exemption, Coogan said. “Many legislators say they support it, but their support would be in the form of a ‘yes’ vote on a bill.”

So far, PAMES has been unsuccessful at getting the bill that far. It gets bottlenecked in the rules committee, Coogan said, “so we are working [to come up with] a new strategy. The frontal assault is not working,”

He said he was encouraged by GAMES’ success. “I was just amazed they were able to get it through in one session,” he said.

Washington isn’t the only state with issues, however.

Coogan and the PAMES membership have also been grappling with a 16.9 percent reduction in Medicaid that took effect in November in Oregon. “We negotiated a temporary solution by giving up a cost-of-living-adjustment over the next two years,” he said.

That brought reimbursement back up to 95.5 percent of what it had been, Coogan said. PAMES has appealed to the state emergency board to get the remaining 4.5 percent reinstated.

Even though providers in most states are dealing with Medicaid problems and other individual issues, state association directors said competitive bidding remains the overwhelming concern.

Liz Moran, executive director of the Medical Equipment Suppliers Association, which works with providers in Arkansas, Louisiana, Oklahoma and Texas, said competitive bidding has been MESA’s key focus. “Everybody is so focused on that and trying to get this one-year delay,” she said. “That’s the elephant in the room. Whatever else is going on pales compared to that. It’s a bad idea badly executed.”

Heartland Conference Begins Today
WATERLOO, Iowa--This week, nearly 1,000 HME providers, manufacturers and speakers are expected in Waterloo, Iowa, for the VGM Group’s Heartland Conference 2008.

Set to kick off tonight, the primary conference venue will be the Five Sullivan Brothers Convention Center, and the Waterloo Center for the Arts will also be used. While the annual event is famous for its hog roast, officials say this year’s conference will offer more than the perfect pig.

“The Heartland Conference hosts a record number of educational offerings this year,” said VGM's Sara Bauer, vice president of education, noting 90 speakers will present more than 100 sessions in eight tracks: executive, operations, rehab, regulatory, products and technology, reimbursement, respiratory and sales and marketing.

Additionally, Bauer said, “attendees can receive up to eight different types of continuing education credits.”

A variety of special sessions--including Billing Boot Camp, the Certified Environmental Access Consultant (CEAC) exam, U.S. Rehab technical training, Assistive Technology Supplier/Practitioner training and Wound Care/Bariatrics--will run during the week before Heartland’s official close on Thursday. Individuals will sit for the Rehabilitation Engineering and Assistive Technology Society of North America (RESNA) exam on Friday.

According to VGM President Ron Bendell, "The Heartland Conference is critically important to the industry at this time because [providers] will obtain the latest information with regard to managing competitive bidding and other reimbursement issues such as the [Deficit Reduction Act], understanding and coping with government fraud, abuse and other regulatory initiatives and developing methods to expand their business opportunities.

"The conference allows providers to network with other providers and learn how others are coping with and thriving in today’s ever-changing environment.”

For more information, visit www.vgmheartland.com.


In Brief
Nielsen Business Media announced Friday that Kevin Gaffney has been hired as show director of Medtrade and Medtrade Spring. Most recently, Gaffney served as sales and marketing director for the Exhibit Designers and Producers Association. Credentialed by the International Association of Exhibitions and Events as a Certified Exposition Manager, Gaffney is an instructor in the University of Georgia’s Meeting Certificate Program and serves on the Industry Advisory Board for the Cecil B. Day School of Hospitality at Georgia State University. “Kevin’s knowledge of the trade show industry and his proven success in business development, sales and operations will enable the Medtrade events to directly respond to the home health care industry’s current challenges,” said Nielsen's Joe Randall, senior vice president. Randall will also continue his involvement in the events, he said: “More than ever, Nielsen Business Media and, I personally, are committed to the industry and will continue to work with our partners, exhibitors and attendees to ensure Medtrade and Medtrade Spring exceed their expectations.” Medtrade 2008 is set Oct. 27–30 at the Georgia World Congress Center in Atlanta. Medtrade Spring will take place at the Las Vegas Convention Center March 24–26, 2009. For more information, visit www.medtrade.com or call 800/933-8735.

The American Academy of Sleep Medicine has launched a blog at www.sleepmeeting.blogspot.com that will have live updates from SLEEP 2008 when it opens today. More than 1,150 research abstracts will present the latest findings in sleep research to more than 5,000 scientists and sleep specialists at the 22nd annual event, a joint venture of the American Academy of Sleep Medicine and the Sleep Research Society. The scientific program will also include more than 85 symposia, clinical workshops and discussion groups on topics ranging from neuroscience and genetics to the diagnosis and treatment of sleep disorders such as insomnia, narcolepsy and sleep apnea.

In the first overhaul of regulations governing the hospice industry since 1983, a new regulation outlines the right of Medicare beneficiaries to determine how they receive end-of-life care. The new Medicare Conditions of Participation includes explicit language that had not previously existed and sets out a detailed list of patient rights. Specifically, the rule says, patients who choose hospice or palliative care over curative treatment are entitled to participate in their treatment plan, the right to effective pain management, the right to refuse treatment and the right to choose their own physician. The regulation was published in the Federal Register June 5 and can be viewed at www.cms.hhs.gov/CFCsAndCoPs/05_Hospice.asp.

NPI compliance is better than expected, CMS said last week, with most of the Medicare contractors reporting over 90 percent of claims are NPI-compliant. CMS is also reporting “few problems,” but noted that, on May 23, there were “a number of rejections for claims with legacy numbers in the secondary provider identifier field.” While the agency is seeing some issues in some areas of the country, CMS said, "progress has been substantial in recent days and weeks and this favorable trend is expected to continue.” For more information on the NPI, go to www.cms.hhs.gov/NationalProvIdentStand.

Last week, Dynamic Response Group announced the first phase of its direct-to-consumer business plan for subsidiary Medico Express, which will become a DME provider focused exclusively on chronic diseases affecting the Hispanic community in the United States, Puerto Rico and the Virgin Islands. The company said it will identify critical care products that improve its customers' quality of life with delivery directly to their homes as prescribed by physicians. The company "will make Medicare and Medicaid fully accessible to the Hispanic community by eliminating the perceived bureaucratic roadblocks, upfront payment considerations and legitimate language barriers for obtaining benefits for the elderly and disabled," the company said. Medico's current focus is distribution of products for the treatment of type II diabetes specifically because of its disproportionate impact and increasing diagnosis rate within the U.S. Hispanic population. In the next phase of its plan, the company said it will test the program on Univision, Telemundo and Telefutura in key Hispanic Medicare markets.

Invacare's Top End sports and recreation rehab division has won the order to build more than 240 wheelchairs for the Chinese Paralympian team. The order includes multiple styles of wheelchairs that will be used for basketball, racing, quad rugby, tennis, boccia, shooting, table tennis and archery. In addition, Top End will provide 130 Top End Crossfire T6 wheelchairs for the athletes to use when they are not competing. China is one of the few countries that purchases equipment for its Paralympic athletes, Invacare said. The Paralympics will take place Sept. 6-17 in Beijing, China.

The Office of the National Coordinator for health information technology said last week it will focus on improved patient care and public health protection through the adoption of health IT over the next five years. The new five-year plan will push the adoption of electronic health records, which President Bush has called for. But creation and widespread use of a nationwide health information network is not assured. ONC technology director John Loonsk said issues including the lack of a clear benefit for providers to buy and use the systems, as well as privacy concerns, may cause roadblocks. To view the plan, click here.

In another nab for the Medicare Fraud Strike Force, 11 HME owners and operators in the Los Angeles area have been indicted on charges of submitting false claims to Medicare, according to a Department of Justice announcement. The indictments followed raids on the HMEs and resulted in the arrests of 10 individuals. The DOJ said the indictments cover nearly $13 million in fraudulent claims to Medicare, and defendants have been charged with conspiracy to commit health care fraud, advising or participating in a fraud scheme and aggravated identity theft.

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