HME News

SEP 2018

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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■ More and more providers are making the switch to electronic documentation, says Ronda Buhrmester. See page 4. Q&A: Peter Cramton on proposed bid changes . . . . . . . . . 1 Stakeholders fine-tuned message in August . . . . . . . . . . . 3 Newspoll: Providers divided on benefits of lobbying . . . . . 3 Budget neutrality wreaks more havoc for oxygen . . . . . . . 3 News Briefs Another court issues TRO on CMS BROWNSVILLE, Texas – A court has again is- sued a temporary restraining order prohib- iting CMS from recouping overpayments until after the administrative law judge level, this time on behalf of Adams EMS, according to healthcare attorney Elizabeth Hogue. In June, the U.S. District Court for the Northern District of Texas issued a TRO on behalf of Family Rehabilitation. In this most recent case before the U.S. District Court for the Southern District of Texas, Health Integrity, a ZPIC, determined that Adams EMS received $148,035 in overpayments on claims submitted from July 17, 2012, to Jan. 15, 2016, an amount it extrapolated to $418,035. Adams suc- cessfully argued that it was being deprived of due process because of the massive backlog at the ALJ and that recoupment before it had its day in appeals court would put the company out of business. West Virginia lawmakers go to bat for HME WASHINGTON – A group of senators and rep- resentatives from West Virginia has sent a letter to CMS Administrator Seema Verma saying the agency's May 9 interim final rule "does not go far enough" to ensure contin- ued access to DME for the elderly and dis- abled in rural areas. The group points out that, while the IFR reinstates 50/50 blended reimbursement rates, it only does so for rural and non-contiguous areas, not all non-com- petitive bidding areas. "We were hopeful that the IFR would prevent further closures and begin to move toward adequate reimburse- ment for our providers by addressing this is- sue," the group wrote in the July 18 letter. "Unfortunately, this did not occur." Ms. Wheelchair protests incontinence program SAINT PAUL, Minn. – Sheri Melander-Smith, Ms. Wheelchair America, has filed an of- ficial protest with the Minnesota Depart- ment of Human Services to object its plans to implement a preferred inconti- nence product program that would award a contract to a single company, MAMES reports. Melander-Smith also signed a pe- tition requesting that DHS initiate an offi- cial rulemaking process before the Office of Administrative Hearings. Marx, Maughan join AAHomecare board WASHINGTON – AAHomecare has added two new members to its board of directors: Scott Maughan, president of Salt Lake City-based Alpine Home Medical; and Josh Marx, man- aging director of sleep and vice president of business development for Cleveland-based Medical Service Company. "We're extremely fortunate to add these accomplished individ- uals to our leadership team," said Tom Ryan, president and CEO of AAHomecare. "I know that the association will benefit from their demonstrated passion and commitment to this industry." WWW . HMENEWS . COM / SE p TEM b ER 2018 / HME NEWS 3 By Liz Beau L ieu, e ditor WASHINGTON – CMS's proposed changes to the home oxygen ben- efit would ding reimbursement for portable equipment and por- table gas contents, as well as oxy- gen generating portable equip- ment (OPGE). Per a recently released pro- posed rule, the agency seeks to create two separate payment classes for liquid equipment and liquid contents, and to apply a "budget neutrality offset" to all classes, not just stationary equip- ment and oxygen contents. The end result, per an example provided by CMS: Reimburse- ment would drop from $17.29 per month to $16.04 for porta- By Theresa F L aher T y, Managing e ditor WASHINGTON – In August, as law- makers headed into their recess, industry stakeholders kept the focus on a recent proposed rule overhauling Medicare's competi- tive bidding program. CMS is accepting comments on the proposed rule, which would, among other things, not extend the current bid contracts and temporarily allow any Medi- care-enrolled provider to serve beneficiaries, until Sept. 10. "CMS has made some dramat- ic improvements, but we're lining up some additional refinements and tinkering with the details," said Cara Bachenheimer, chair of the government affairs practice at Brown & Fortunato. "I think keeping legislators involved and sharing how the industry feels about where CMS is at is impor- tant to communicate over the next few weeks." Industry response to the rule, which would also swap median price for clearing price, has been largely positive. However, the proposed "any willing provider" provision could actually create more, not fewer, access issues, says Karyn Estrella, executive director of the Home Medical Equipment and Services Association of New England, who will be talking up the issue with lawmakers in the By Liz Beau L ieu, e ditor T HE RES ul TS of a recent HME Newspoll show an industry divided over the benefits of lobbying, with one camp citing Medicare as a lost cause and another believ- ing too much is at stake not to advocate. Only 47% of respondents to the poll say they submitted comments to a recent interim final rule that laid out CMS's plans to offer relief from com- petitive bidding, but only from June 1, 2018, through Dec. 31, 2018. Stakeholders fine-tune message Is lobbying lethargy setting in? Not so, says one poll respondent: 'If we don't drive change, nobody will' region in August. "Contracted suppliers are no longer bound by these large CBAs," she said. "I know one large oxygen supplier who said they are going to significantly reduce their service area." Also a topic in August meet- ings: H.R. 4229, a bill that would extend 50/50 reimbursement rates and address the oxygen "double dip." VGM's John Gal- lagher and several HME provid- ers met with the bill's sponsor, Rep. Cathy McMorris Rodgers, R-Wash., on Aug. 6. "We need to see what needs to be adjusted in the language going forward," said Gallagher, vice president of government relations for VGM. "Our hope is that CMS makes the adjust- ments in the final rule, but we still have to have the language to use as a club to say, 'Change it.'" hme "If the rates from July 1, 2016, are allowed to remain in place after Dec. 31, 2018, the business model is unsustainable, because of the amount of support staff necessary to docu- ment, bill and fight audits on HME," wrote Chuck Wil- liams of Williams Bros. Health Care Pharmacy in Wash- ington, Ind., who submitted comments. Among the 53% of respon- dents who didn't submit com- ments was Shalon James of Access2Mobility in Tyler, Texas. She says she has participated in lobbying efforts in the past, but because her business is in a non- bid area, it's less impacted by the program. "(Also,) I have not recently participated in the efforts to reform competitive bidding because, frankly, I feel that it won't do any good, not with the peo- ple we currently have in office," she wrote. "It is my hope that, after the November elec- tions, we will start seeing some positive changes." That may be the reason why 77% of respondents say they do not plan to schedule a meeting with their lawmakers to discuss bid relief when they're back in their home districts for the August recess. A meeting with the VP VGM's Government Relations team was busy in July, meet- ing with many legislators and even meeting with Vice President Mike Pence. VGM's Collin Brecher and Emily Harken met with Pence during his visit to Cedar Rapids, Iowa. They were able to get a minute with the vice president to discuss challenges facing the DME industry. Afterward, they were able to have a much more in-depth discussion with Pence's staff members. From left: Pence, Harken, Brecher and state representative Rod Blum. Budget neutrality wreaks more havoc ble equipment; from $53.32 to $49.46 for portable gas contents; and from $37.44 to $34.73 for OPGE, based on fully adjusted fee schedule amounts for non- rural areas in the Southeast. "Depending on a provider's business mix and the modalities they provide, this could result in more cuts," said Cara Bachen- heimer, chair of the government affairs practice at Brown & Fortu- nato. "We believe CMS has sim- ply exceeded its authority when it applies budget neutrality to bid pricing." Per CMS's example, reim- bursement for stationary oxygen equipment and oxygen contents, however, would rise from $70.23 L E T H A R G y s E E PA G E 4 H AV O c s E E PA G E 4 HME NEWS POLL oxygen Karyn Estrella John Gallagher

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