HME News

FEB 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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Mobility h M e N e WS / Feb R ua R y 2018 / WWW .h M e N e WS . C o M 15 Will 2018 be the year of widespread prior auths? authorizations to the remaining states and also require them for complex rehab wheelchairs. " t he demo has been very success- ful, from a provider perspective and CMS perspective," Johnson said During the demo for standard power wheelchairs, CMS also start- ed requiring prior authorizations for two complex rehab codes, K0856 and K0861, in 2017. "We'd like to see it become stan- dard procedure across the board," Johnson said. t he demo kicked off in seven states in September 2012 and was expanded to 12 states in 2014, bringing the total to 19. HME SOUTH DAKOTA C O n t i n U E d f R O M P R E v i O U S PA g E turnaround time for approving prior authorizations for repairs would have to be within 24 hours, Coy says. " i f something breaks, we need to take care of it right away," she said. " i don't even think repairs should be included." Whether or not states require prior authorizations for repairs varies from state to state, says Don Clayback, and for those that do, he emphasizes the need to create reasonable thresholds. For exam- ple: Maybe a state doesn't require prior authorizations for the first two batteries in a 12-month period, but it does for anything over and above that. " t hat way the provider can make these repairs in a timely manner and it doesn't tie up the administrative process," said Clayback, executive director of n CA rt . While Coy has concerns about requir- ing prior authorizations for repairs, she approves of the process, in general. "We put out some high-end wheel- chairs and there are a lot of dollars included in that," she said. " i f we can get a prior authorization, we feel much bet- ter about providing that chair and know- ing we're going to get paid for it." HME PRIOR AUTHS C O n t i n U E d f R O M P R E v i O U S PA g E time." t he act also calls on the VA to develop a provider certification process using manu- facturers or third-party, nonprofit organiza- tions; train the personnel administering its Automobile Adaptive Equipment program; and allow veterans to receive modifications at their homes. Stakeholders know the VA has been working on the standards: i t released a request for information early in 2017 and then received oral testimony at its headquarters in Washington, D.C., that summer. "We were told at the meeting that the proposed rule would be released late sum- mer, early fall," Johnson said, "and that they weren't really going to be able to pro- vide much insight with regard to the make- up of the rule, and that's still pretty much where we are. i t has been radio silent." i n their comments to the VA, stakehold- ers emphasized that veterans should be able to receive modifications at their homes or the location of their choice, and that no one manufacturer should be able to control the certification process. " t he biggest thing we want to know is: Who are the certifying bodies?" said John Gallagher, vice president of government relations for VGM. Another concern emphasized: that there should be differentiation in the standards for complex and simple modifications. Pro- viders who "chop a vehicle in half" to mod- ify it and providers that attach a wheelchair lift to the back of a vehicle shouldn't be held to the same standards, Johnson said. "We're confident that there will be some type of differentiation," he said. Gallagher suspects that, because the handbook is currently unavailable on the VA's website, it's possible the agency is in the process of updating it. " i 'm thinking it will be some time this spring," he said. HME INDUSTR y AWAITS VA STANDARDS FOR m ODIFICATIONS C O n t i n U E d f R O M PA g E 1 By Liz Beau L ieu, e ditor T HE B i G story in mobility for 2017 was CMS's new prior authoriza- tion program for two complex rehab codes, K0856 and K0861. a u T ho R ize T hi S Prior authorizations were the subject of two of the most read stories for 2017: "CMS announces first codes up for PA process" ( n o. 2) and " i t's a bumpy start for prior authorizations" ( n o. 4). Mobility providers are no strangers to prior authorizations, which CMS already requires in 19 states for stan- dard power wheelchairs as part of a demonstration project, but there are hiccups with any new program. i n this case, stakeholders felt, at least initially, that providers didn't have all the information they needed to comply most read stories with the program. But by and large, stakeholders support this new program, as well as the demo. Complex rehab wheelchairs are costly to provide, and prior authorizations give providers a level of confidence that they'll get paid for their work. Stakeholders have actually made the case for requiring prior authoriza- tions for standard power wheelchairs in all states and for all complex rehab wheelchairs. With the demo set to expire in August, CMS has the opportunity, stakeholders say, to do just that. Will 2018 be the year of widespread prior authorizations? aCC e SS ible—a N d SM a RT Another subject that dominated the m o s t re a d s t o r i e s i n 2 0 1 7 : h o m e modifications. i n the n o. 1 story, " n SM sees 'steady growth' in home accessibility," the national complex rehab provider provides an update on Access n SM, which grew to 14 locations in 12 states in 2017. n ow that n SM and n umotion have consolidated much of the complex rehab market, they're looking for addi- tional ways to grow their businesses, and home modifications, which are needed by a similar customer base, fits the bill. i n the n o. 3 story, "Group sets off movement for home modifications," this niche business gets further play, with stakeholders organizing behind a bill in the House of r epresentatives that would give seniors a $30,000 tax credit for modifying their homes to help them age in place. With the VGM Group also making a concerted push in this market (rebrand- ing its Accessible Home i mprovement of America to VGM Live at Home to expand its coverage to smart sen- sors and other home health technol- ogy), we're also watching this space in 2018. HME #1 NSM SEES ' S t E ady growt H ' i N H o ME acc ESS ibility #2 c MS a NN ou N c ES fir S t cod ES up for pa proc ESS #3 g roup SE t S off M ov EMEN t for H o ME M odificatio NS #4 i t' S a bu M py S tart for prior aut H orizatio NS #5 c MS li M it S K0108 for M a N ual w HEE lc H air S " t he biggest thing we want to know is: Who are the certifying bodies?" Silver sponsor: You need to be at this event! Review the program and register online: Attend the Home Health Technology Summit and hear from industry experts on the cutting edge of home health technology. Learn how it can improve patient outcomes, increase effi ciency and generate revenue for your business! Sessions include: The impact of technology on home health care Smart home technology and the ethics of data Remote patient monitoring as a standard of care Payers investing in health care technology And more! Smart home technology and the ethics of data Remote patient monitoring as a standard of care Payers investing in health care technology Astor Crowne Plaza New Orleans, LA March 4-6, 2018

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