HME News

MAR 2017

HME News is the monthly business newspaper for home medical equipment providers. This controlled circulation publication reaches 17,100 home medical equipment services providers, including traditional HME dealers & suppliers, hospital- and pharmacy-o

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News Briefs HHS finalizes appeals rule WASHINGTON – The Department of Health and Human Services has published a final rule that addresses the massive appeals backlog. The proposed rule, published in July, established precedential authority to the fourth level of appeals and created attorney adjudicators at the third level of appeals. The final rule did not have major modifications. It will go into effect March 20. CMS issues guidance for dual-eligibles WASHINGTON – CMS has published guidance to help states ensure access to DMEPOS is available for dual-eligible beneficiaries. Those strategies are: recommend prior ap- proval; ensure DME claims for dual-eligibles are assessed against Medicaid's broader coverage criteria; and ensure Medicaid is only looking for Medicare prior authoriza- tions on those items and in those states that Medicare requires it. The guidance also states that states should consider incorpo- rating these requirements and strategies into contracts with Medicaid MCOs. AAHomecare to Tricare: Reprocess claims WASHINGTON – AAHomecare is calling on the contractors administering Tricare military health plans nationwide to reprocess claims for HME for the last six months of 2016. Congress directed Medicare to do just that in a provision included in the 21st Century Cures Act passed in December. AAHomec- are argues that since Tricare reimbursement rates are pegged to Medicare reimburse- ment rates by law and by current network agreements, these plans are obligated to follow suit. The association has sent a letter to the three contractors administering the Tricare plans and the Department of De- fense outlining its argument. Price says audits should focus on actual fraud WASHINGTON – Rep. Tom Price, R-Ga., the new secretary of Department of Health and Human Services, told members of the Sen- ate Finance Committee that he thinks the agency should focus audits on weeding out blatant fraud instead of verifying medi- cal necessity. The comments came in re- sponse to a question from Sen. Orrin Hatch, R-Utah, about what HHS can do to protect Medicaid from scammers, according to an article on Law360. Safeguard Services tapped for UPIC contract CAMP HILL, Pa. – SafeGuard Services has been awarded the Unified Program In- tegrity Contractor (UPIC) for the North- eastern Jurisdiction. UPICs are new CMS contractors that will replace the functions of: Zone Program Integrity Contractor (ZPIC), Program Safeguard Contractor (PSC), and Medicaid Integrity Contractor (MIC). ■ AAHomecare has formed a work group to explore new oxygen payment model, says Tom Ryan. See story this page. CMS delays Round 1 2019 . . . . . . . . . . . . . . . . . . . . . . . . . . 1 Newspoll: HME bucks, embraces retail trends . . . . . . . . . 4 Roberta Domos refocuses consulting biz . . . . . . . . . . . . . . 6 CMS issues guidance for bid-rate relief . . . . . . . . . . . . . . . 8 4 HM e new S / M ARCH 2017 / www. HM enew S . C o M slow & steady By Liz Beau L ieu, e ditor WASHINGTON – A directive from Congress to tie Medicaid reimbursement to Medicare reim- bursement will be a tough pill to swallow for not only HME providers but also states, industry stakeholders say. A "pay for" in the 21st Century Cures Act stipulates that the federal govern- ment's share of Medicaid reimbursement to states for DME be limited to Medicare payment rates, rates that have been deci- mated by subsequent rounds of competi- tive bidding. "The states and the DME providers are in the same boat," said Cara Bachenheimer, senior vice president of government relations for Invacare. "The states are going to get less money and the big question now is, how are they going to deal with that?" The change in Medicaid reimbursement is slated for Jan. 1, 2018. AAHomecare convened a sub-group of its Regulatory Council recently to strategize By Liz Beau L ieu, e ditor T HE l AR g ER trends in retail may point to the cloud, but for HME providers, it's still all about bricks and mortar, according to a recent HME Newspoll. A large majority of respondents to the poll (71%) say they are focusing their retail efforts in-store, not online. That's because, accord- ing to a large majority of respondents (78%), WASHINGTON – The Senate on Feb. 10 approved the nomination of Rep. Tom Price, R- g a., as secretary of the Depart- ment of Health and Human Services. The Senate voted 52 to 47 to confirm Price, a long-time champion of the HME industry. "Dr. Price has a strong appreciation of the role that home medical equipment providers play in allowing people to remain in their homes when recuperating from an illness or dealing with long-term health changes," said Tom Ryan, president and CEO of AAHomecare, in a statement. Price, the architect of an alternative to Medicare's competitive bidding program called the market-pricing program, is a popular choice among HME stakehold- ers. His long-standing desire to repeal and replace the Affordable Care Act, popular with President Donald Trump and Repub- licans, also resonates with stakeholders. In overseeing HHS, Price will man- age an annual budget of more than $1 trillion. hme By Theresa F L aher T y, Managing e ditor WASHINGTON – Industry stakehold- ers have begun developing drafts for an alternative payment model for respiratory care, but they're taking it one step at a time. "We want to have buy-in from everybody," said Tom Ryan, pres- ident and CEO of AAHomecare. "We want to bring other groups into the discussion, but until we have a couple of models, we are still in the initial discussion By Liz Beau L ieu, e ditor WASHINGTON – The members of AAHomecare's new Hi Tech Work g roup will meet face-to- face at Medtrade Spring to set next steps in their goal of get- ting private payers to increase reimbursement for new oxygen and sleep therapy technology, or create new payment models for them. l eading up to the event, Stakeholders home in on Medicaid strategy 'The states are going to get less money and the big question now is, how are they going to deal with that?' how to best handle the change in Medicaid reimbursement. What the 15 members came away realizing: There are a lot of questions that need to be answered. " l ike a lot of laws, it gets passed and then everyone goes, 'How does it actually get implemented?'" said Kim Brummett, vice president of regulatory affairs for AAHomecare. "What are the states actually required to do?" It's Brummett's sense that the money the states get from the federal gov- ernment for Medicaid isn't tied to the Medicare fee schedule per se, but to a formula. So the big question isn't, do they have to match the bid rates, but, how does that formula change, she says. Members of the sub-group are research- ing this and other details, so they can then approach state Medicaid programs with "real- ly good information," Brummett said. "We want to be able to go to them and say, 'This is a law, here is a legal opinion (on how to implement it),'" she said. hme Tom Price in as HHS secretary Work group aims to 'reframe' payment for new technology members of the work group were gathering information about how payments for other product categories have been reshaped. One recent example: CMS classified "therapeutic" continuous glucose monitors as DME and assigned them a one-time payment of $236- $277, plus bundled monthly payments for supplies. "It's interesting that they There's no rush to create alternative payments phase." AAHomecare kick-started the effort earlier this year, after sur- veying respiratory stakeholders to gauge support. A workgroup, comprised of AAHomecare HME/Respirato- ry council members, is draft- ing several patient-centered models using existing clinical standards, like those set out by the g lobal Initiative for Chron- ic Obstructive l ung Disease HME providers stay grounded in retail biz their customers prefer to buy HME in-store. "Our elderly clients still want to touch the item before they buy it," said Kevin Jones of Travis Medical in Oklahoma. "They are also scared of identity theft." Deb Swaim of Riverside Health Equipment in Illinois agrees. "The demographics of the customers in our location prefer to see and feel the items vs. purchasing online," she said. Several respondents did make the distinc- tion that a customer's preference to buy in-store vs. online HM e NEWS POLL O x y G e N m o d e l s e e pa g e 6 T e C H N O L O G y s e e pa g e 8 r e TA I L s e e pa g e 6 Bachenheimer

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