HME News

OCT 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 Superior HealthPlan makes changes to Medline contract AUSTIN, Texas – Superior HealthPlan, a man- aged care company that's administering part of the state's Medicaid program, has decided to delay a contract with Medline until Oct. 1, according to the San Antonio Express-News. The contract, which in- cludes 244 codes for DME and supplies, was set to start Sept. 1. Superior Health Plan, part of Centene Corp., also plans to recast the contract as "preferred provider" vs. "single source," making it clearer that Medicaid recipients will still have their choice of provider, the newspaper reported. The changes to the contract come on the heels of a hearing before the state's Com- mittee on Human Services in the House of Representatives on Aug. 9. During the hearing, lawmakers suggested that Supe- rior HealthPlan amend its notice to patients to say they can "opt out for any reason or no reason at all," the newspaper reported. Prior to the hearing, a number of providers, including Respiratory & Medical Homec- are and Alliance Medical Supply, had sent letters of protest to different offices of the Texas Health and Human Services Com- mission, as well as Superior HealthPlan. Superior HealthPlan's contract in Texas is only one of many such contracts between managed care companies and distributors spreading nationwide. Study: Bid program puts Medicare more in line with commercial insurers BETHESDA, Md. – A comparison of the prices Medicare paid for certain DME under its competitive bidding program in 2010 and the average prices that commercial insurers paid that same year supports the conclu- sion that CMS overpaid for DME, accord- ing to a new study conducted by the Health Care Cost Institute and published recently in Health Affairs. On average, the Round 1 Re- bid prices for the seven items included in the study were 34.7% lower than the prices in the Medicare fee schedule for 2010. On av- erage, commercial payers paid 28.7% less than Medicare for the same items in 2010. The Health Care Cost Institute is a non- partisan, non-profit organization that aims to provide complete, accurate, unbiased information about healthcare utilization and costs to better understand the U.S. health- care system. Date stamp requirement updated WASHINGTON – The DME MACs have up- dated the Dear Physician letter to remove the requirement for a date stamp or similar to prove a supplier has received a written order prior to delivery of an item, accord- ing to a bulletin from AAHomecare. Now, the date of the physician signature must be on or before the date of delivery. The requirement is mandated by the Affordable Care Act. ■ New IFR sounds promising, but let's wait and see, says VGM's John Gallagher. See story this page. MCOs shift Medicaid landscape . . . . . . . . . . . . . . . . . . . . . 1 Round 2019 remains a mystery . . . . . . . . . . . . . . . . . . . . . . 4 Providers press the flesh in August . . . . . . . . . . . . . . . . . . . 6 Q&A: Jeff Baird . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 8 4 HM e new S / octo B er 2017 / www. HM enew S .co M By T. Flaher T y, Managing e ditor WASHINGTON – As Hurricane Irma barreled toward Florida in early September, industry stakehold- ers met with CMS officials to discuss serious issues that arise in disaster situations. One thing being discussed: Whether there is a possibility of getting the Federal Emer- gency Management Agency to pay for oxygen tanks in such situations, says Tom Ryan, president and CEO of AAHomecare. "If CMS indicates (there could be) a gap in coverage— and Laurence Wilson seems willing to do that—it'll notify FEMA," he said. "I am also reaching out to FEMA. We have to quickly determine how we can get a funding stream and get ourselves teed up." CMS did provide some relief in the wake of Hurricane Har- vey, issuing guidance stat- ing that it will pay for bene- ficiary-owned DME that has been damaged or destroyed in circumstances related to a declared emergency. Stakeholders say that storm, By Theresa Flaher T y, Managing e ditor WASHINGTON – From accreditation to audits, HME providers let panel members at a Small Busi- ness Administration hearing in August know exactly what they think of burdensome regulations. For provider Craig Rae, the cost of maintaining accredita- tion ranks at the top of his list. He estimates one-third of his staff does nothing but scrutinize minutiae to meet the compli- ance standards set forth in six categories—the first of which has seven sections containing 113 separate standards requiring documentation. "Our industry fully supports establishing effective measures to protect beneficiaries and reduce waste, fraud, and abuse, but only a bureaucrat could love what it's become," said Rae, owner of Salisbury, N.C.-based Penrod Medical Equipment, at the Aug. 28 hearing in Wash- ington, D.C. "For example, if a customer leaves a message after hours asking 'Are you open Sat- urdays?,' we need to log the call, what time it came in, and keep a record of when we returned the call." Don't even get him started on By l iz Beaulieu, e ditor WASHINGTON – HME providers shouldn't be worried that they're closing in on one year before the launch of Round 2019 of competi- tive bidding and they don't have any details on how CMS plans to proceed, stakeholders say. CMS announced ear- lier this year that it would temporarily delay Round 2019 to give the new administration, including Tom Price, secre- tary of the U.S. Department of Health and Human Services, time to review the program. Since then, it has been radio silence. Round 2019 remains a mystery "That it's taking this long for them to make another announcement means there are changes being made," said John Galla- gher, vice president of government relations for The VGM Group. "I think the longer it takes, the better it's going to be." CMS delayed Round 2019 on Feb. 7, just about a week after detailing its plans for the next round on Jan. 31. Those plans includ- ed a number of changes to the program, like adding a new product category for insulin pumps and supplies, implementing a lead- item bidding methodology, and introducing a bundled program for CPAP devices and sup- plies in five bid areas. What changes are in play behind the scenes—the original changes and/or other changes that are in line with Price's previ- ous efforts to replace the competitive bidding program with a market-pricing program—are unknown, stakeholders say. "We don't know what direction they're going in, or how far they're going," said Cara Bachenheimer, senior vice president of government relations for Invacare. "But I don't think anyone should be worried: Price By l iz Beaulieu, e ditor T HE WEBSITE of the Office of Infor- mation and Regulatory Affairs and the Office of Management and Budget now shows an interim final rule pending review titled "Durable Medical Equipment Fee Schedule, Adjustments to Resume the Transitional 50/50 Blended 'That it's taking this long for them to make another announcement means changes are being made' All eyes on new rule competitive bidding r U l E s e e pa g e 8 Providers tell SBA: Monitoring clipboards doesn't curb fraud which made landfall on the Texas Gulf Coast on Aug. 25, made it quickly apparent that Medicare rules limiting the provision of HME to only con- tract suppli- ers in com- petitive bid- ding areas like Hous- ton, and the inability to get replace- ment tanks paid for, are shortsighted. "There is a possibility that there are going to be access issues, that the contracted suppliers will not be able to handle the increased capacity during this emergent situa- tion," said Ryan. Stakeholders say it's also time to revisit longstanding policy that providers can- not be paid for the back-up tanks they put out in such situations. While in the past, providers absorbed the hit, today's reimbursement rates make that unfeasible, says Ryan who, as a former pro- vider, speaks from experience. Disaster relief: Stakeholders press for changes HIPAA compliance rules dictat- ing the type of clipboards he can use and the correct way to place d o c u m e n t s on those clip- boards. " T h e s e things have nothing to do with reducing fraud," he said. "They are just so far overreaching, telling us how to manage our business." Provider Frank Trammell's key point of contention: audits run amok. "There's a lack of transparen- cy and the fact that the differ- ent levels of appeal clearly have different rules," said Tram- mell, CEO of Matthews, N.C.- based Carolina's Home Medical Equipment, who restructured his business a few years ago just to keep up. "The denial tends to be rubberstamped at redetermination, and then 80% are being overturned if it makes it in five years to the Adminis- trative Law Judge. We've never lost an appeal at the ALJ." The SBA holds hearings sev- eral times a year around the country business. hme D I S A S T E r r e l i e f s e e pa g e 6 r O U N D 2 0 1 9 s e e pa g e 6 Tom Ryan Bachenheimer Frank Trammell

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