HME News

JUN 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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Adjusted fee schedule not what Congress intended . . . . . 3 Newspoll: Providers struggle to stay afloat . . . . . . . . . . . . 3 CMS implements audit improvements . . . . . . . . . . . . . . . . 3 MAMES honors provider Lelia Wilkerson . . . . . . . . . . . . . . 4 ■ Provider Doug Westerdahl had to lay off 10 employees this year. See story page 1. News www.hme N / ju N e 2017 / hme N ews 3 Board taps Bowen to lead N eme P ALBANY, N.Y. – Just months after New York and New Jersey combined their state HME associations, they have announced new leadership. The board of directors of the Northeast Medical Equipment Provid- ers association (NEMEP) has chosen Beth Bowen, who already leads state HME as- sociations in Florida, North Carolina, Ten- nessee and Virginia, as their new execu- tive director. "NEMEP is very lucky to have such a distinguished and energetic profes- sional at its helm," Kim Voelker, the former executive director of NEMEP, wrote in a letter to members on April 11. m ass h ealth moves toward preferred manufacturers BOSTON – MassHealth has published a request for response for a preferred manufacturer/distributor for incontinence products, according to the Home Medi- cal Equipment Services Association of New England. Tom Lane, the director of MassHealth's Fee-for-Service Programs, told HOMES, however, that the preferred manufacturer/distributor would be required to work with the HME provider network. The bid opening date was scheduled for May 1. A number of states have explored similar models for incontinence supplies, including Illinois and South Carolina. Georgia passes licensure requirement ATLANTA – Georgia Gov. Nathan Deal has signed into law a bill that establishes li- censure requirements for DME. Under the requirement, a supplier must submit the appropriate forms as prescribed by the Georgia State Board of Pharmacy, submit the requisite license fee, and maintain an office or place of business within Geor- gia. The supplier must also meet safety standards, including ensuring all person- nel engaged in delivery, maintenance and repair of DME receive annual continuing education; provide instruction to the pa- tient or patient's caregiver on how to use DME; receive and respond to complaints from patients; maintain patient records for all patients receiving DME; and properly manage, maintain and service DME. o klahoma considers steep cuts for m edicaid OKLAHOMA CITY, Okla. – The Oklahoma Health Care Authority has had to map out budget scenarios for the upcoming fiscal year based on a 5% to 15% reduction in state appropriations, according to Tulsa World. A cut of 15% would mean elimi- nating some optional benefits and reduc- ing provider rates by up to 25%. Benefits being evaluated for elimination include pharmacy, behavioral health and DME, according to the newspaper. Past budget shortfalls have resulted in eliminating or reducing sleep studies, perinatal and den- tal care, and DME purchases, the news- paper reports. The authority is in charge of the state's Medicaid program, called SoonerCare. By Theresa Flaher T y, Managing e ditor WASHINGTON – While there is "no question" that Congress intend- ed for CMS to reset rural and non-bid area rates for the second half of 2016 to match those of the first half of the year, the agency's decision not to was, tech- nically, legal, say industry stakeholders. "From a strictly legal perspective, CMS is act- ing within the bounds of the law," said Cara Bachen- hiemer, senior vice presi- dent of government rela- tions for Invacare. "So it's a very difficult legal argument to make, saying that con- gressional intent trumps the actual black and white letter of the law." The agency released the updated fee schedule to meet a provision in the Cures Act that requires the agency to retroactively delay a second round of reimburse- ment cuts that went into effect in those areas on July 1, 2016, until Jan. 1, 2017, allowing HME providers to recoup six months worth of payments. By l iz Beaulieu, e ditor A W H o p p I n g 6 5 % o f respondents to a recent HME n ewspoll say they can sustain their businesses for less than a year, if they don't get reimbursement relief. Thirty-six per- cent of respon- dents say they can sustain their businesses for up to six months, and 29% say they can sustain their businesses for six to 12 months. "I have laid off long-time employees and cut benefits like health care, but there is no way to make up for 50%-plus cuts in WA S H I N G T O N – C M S h a s a n n o u n c e d s i g n i f i c a n t improvements to the process- ing of serial claims for capped rental items and certain inex- pensive and non-routinely purchased items, according to a bulletin from AAHomecare. It's an issue that has been a challenge for providers for years and contributed to the massive appeals backlog, the association says. Improvements include: 4 Instructing the DME MACs to change the process by which they adjudicate appeals of serial claims. o nce the rea- son for denial for one claim in a series is resolved at any appeal level, the DME MACs will iden- tify other claims in the same series that were denied for the same or similar reasons, and take that determination into Breath of fresh air Breathe Easy Solutions hosted U.S. Rep. Larry Bucshon, R-Ind., at its Terre Haute, Ind., store on April 24. Company officials and the congressman discussed the challenges facing the HME industry, including the national roll out of competitive bidding-related pricing in 2016. President/CEO Kyle Hoffman said Bucshon is "very well versed" on competitive bidding. "He led us to believe that we are going to see a major shift in legislation surrounding both payments and policy criteria," Hoffman said. "His visit was certainly a breath of fresh air that we needed to hear." Medicare does 'what it wants' Unfortunately, CMS recalcu- lated the rates based on the July 1, 2016, fee schedule instead of the Jan. 1, 2016, fee schedule, resulting in rates that are lower than they should be. "We argued our point with the agency and they stuck with their interpreta- tion," said Tom Ryan, president and CE o of AAHomec- are. "Many peo- ple on the Hill are disappointed." Many providers, meanwhile, took to Twitter to vent their frustration. "Medicare does whatever they want, without any fear of industry efforts or congressional intent," read one tweet. "@Sen p riceMD this has to stop. They are openly defying a congressional order. n o one has the guts to stand up to them," read another. Tougher times ahead: Impact of rate cuts piles up, say providers Medicare," wrote Don Chrysler of n ational Home Health Care in Amarillo, Texas. CMS's decision to apply com- petitive bidding reimbursement rates to non-bid areas in two waves in 2016 has sent ripples throughout the HME industry, f o rc i n g m a n y providers to make drastic changes to their businesses. T h e l a rg e s t number of respondents—37%— says the biggest impact of the cuts on their businesses has been dropping products and services. It's a tough decision that has CMS implements audit improvements consideration when adjudicat- ing such claims. 4 The DME MACs will also communicate favorable decision(s) to the DME QIC and the o ffice of Medicare Hearings and Appeals ( o MHA) to consider when adjudicat- ing related appeals pending at those levels. 4 Instructing the DME MACs to update the CM n in the Vi p S Medicare System (VMS), when appropriate, to reflect when a favorable deci- sion has been rendered for a serial claim, allowing future claims in the same series to pay without requiring suppliers to continually resubmit evidence. 4 Instructing the DME MACs to perform data anal- ysis of all favorable serial claim appeal decisions made over the past three years, in an effort to capture all cur- rently pending appeals in the series that could be included in this initiative. Suppliers do not need to take any action and should not request that their appeal be considered for this initiative. hme hme NEWS POLL f e e S C H E d U L E S E E PA g E 4 N e W S p O L L S E E PA g E 4 money woes Tom Ryan Bachenheimer They include instructing the DME MACs to change the process by which they adjudicate appeals of serial claims

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