HME News

APR 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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■ Stakeholders are 'aghast' at a rural bid proposal, says AAHomecare's Tom Ryan. See story page 1. How can CMS stick to Round 2019 timeline?. . . . . . . . . . . 3 CMS upends oxygen CMN . . . . . . . . . . . . . . . . . . . . . . . . . . 3 Newspoll: Trump falling short. . . . . . . . . . . . . . . . . . . . . . . . 3 Texas providers beat back rate cuts . . . . . . . . . . . . . . . . . . 4 News www.hme N / april 2018 / hme N ews 3 Briefs i ndustry attorney Neil c aesar dies GREENVILLE, S.C. – Neil Caesar, an HME industry attorney and speaker, passed away Feb. 11. The president of the Health Law Center was 60. Caesar died from complications from a lengthy illness. He was a 20-year lung can- cer survivor. A long- time and well-known presence at Medtrade events, Caesar was known in the industry for his healthcare experience, but he was also the presi- dent of South Carolina's American Civil Liberties Union affiliate; an active Life Member of Mensa, the high-IQ society; and a hobbyist in the magical arts, ac- cording to an article in the Greenville News with the headline "Prominent Greenville healthcare attorney Neil Cae- sar dies at 60." Caesar is survived by his wife, Dr. Courtney Kyle Caesar, who he met through Mensa, and his son, Baer. cms updates code list for c ures provision WASHINGTON – AAHomecare has received an updated list of HCPCS codes that are affected by a provision in the 21st Century Cures Act that requires the federal gov- ernment to limit its portion of Medicaid re- imbursement to Medicare reimbursement. The association says 244 codes are now subject to the provision, with 13 codes re- moved and five codes added based on their Medicare spend in the 2017 calendar year. The five codes added are commode chair electric (E0170), enclosed pediatric crib hospital grade (E0300), therapeu- tic CGM receiver/monitor (K0554), POV Group 2 heavy duty for 301-450 pounds (K0807) and POV Group 2 very heavy duty for 451-600 pounds (K0808). h ealth spending to hit 19.7% of GD p by 2026, cms report says WASHINGTON – National health expenditure growth is expected to average 5.5% an- nually over 2017-2026, according to a re- port published in February by the Office of the Actuary at CMS. Growth in national health spending is projected to be faster than projected growth in gross domestic product by 1% point during 2017-2026. As a result, health share of GDP is expect- ed to rise from 17.9% in 2016 to 19.7% by 2026, the report says. Drivers of growth: trends in disposable personal income, in- creases in prices for medical goods and services, and shifts in enrollment from pri- vate health insurance to Medicare that re- sult from the continued aging of the baby- boom generation into Medicare eligibility. For 2017, specifically, growth in national health spending is projected to have been 4.6%. For 2018, growth in national health spending is projected to be 5.3%. By Theresa Flaher T y, Managing e ditor WASHINGTON – It's becoming less and less likely that CMS will make its target implementation date for Round 2019, industry stakeholders say. It has been more than a year since CMS put the brakes on Round 2019 of the competitive bid- ding program, and the agency still hasn't provid- ed an update on its plans for the next bid round. "If I were a betting person, I'd say it's certainly not going to happen on Jan. 1, 2019," said Kim Brummett, vice president of regulatory affairs for AAHomecare. "At the end of the day, the Com- petitive Bidding and Implementation Contractor has a boatload of work to do, analyzing and vet- ting all of the bids." A week after CMS announced Round 2019 in February 2017, the agency said it would tempo- rarily delay the program to give the new admin- istration time to review it. Since then, the Department of Health and Human Services has seen a shuffle in leader- ship, with Alex Azar taking the reins in January, replacing industry champion Tom Price, who resigned in September. "There's been a lot of con- sternation with this program, so maybe Azar wanted to take a fresh look at things," said Cara Bachenheimer, senior vice president of government relations for Invacare. CMS has typically given the bidding process—from bid window opening to contract implementa- tion—about 16 months. With the current Round 1 2017, Round 2 re-compete, and national mail- order program for diabetes set to end on Dec. 31, 2018, stakeholders say CMS could extend the current contracts by six months to buy more time. "With that timing, they have a similar timeline (as past rounds), if they came out with some- thing by the end of March or even into April," said Bachenheimer. "But it seems unfeasible if they stick to business as usual." AAHomecare and other industry stakeholders have continued to make recommendations. hme By l iz Beaulieu, e ditor A l ITT le M o R e than half of respon- dents to a recent HM e N e w s p o l l s a y President Donald Trump hasn't had a positive impact on their business- es in his first year in office, largely because none of the changes he has made have By l iz Beaulieu, e ditor WASHINGTON – CMS has changed the guidelines for reporting a patient's oxygen flow rate on a CMN, a move that will have two serious implications for providers, particularly those servicing the critically ill, says Andrea Stark. First, through new modi- fiers laid out in a Feb. 15 joint DM e MAC publication, CMS has instructed that for patients whose oxygen use differs between day and night, the average flow rate, not the highest flow rate, must be reported on question 5 of the CMN. "They say this is going to simplify the process, but it makes things ten times more complicated," said Stark, a reimbursement consultant for MiraVista ll C. CMS has added three new modifiers, set to go into effect April 1: QA (prescribed amounts of stationary oxy- gen for daytime use while at rest and nighttime use differ and the average of the two amounts is less than 1 liter per minute); QB (prescribed amounts of stationary oxy- gen for daytime use while at rest and nighttime use differ and the average of the two amounts exceeds 4 liters per minute and portable oxy- gen is prescribed); and QR By l iz Beaulieu, e ditor BOSTON – If HM e providers have to deal with a preferred supplier for incontinence sup- plies, a new Medicaid contract in Massachu- setts might be the way to go. Because the contract between MassHealth and Geriatric Medical is a preferred not a single-source contract, providers can still buy incontinence products from other dis- tributors and manufacturers, points out Karyn e strella, president and C eo of the Home Medical e quipment and Services Association of New e ngland (H o M e S). "When it comes to bidding of any kind, this is the best-case scenario we could ask for," she said. The contract between MassHealth and Geriatric Medical, a Woburn, Mass.-based supplier of wholesale medical products to long-term care, home care and nursing home facilities, is set to go live April 15. o ther benefits of the contract include MassHealth's insistence on keeping the provider network intact (other states have allowed distributors to go direct to consum- er, cutting out providers) and its selection of a local company. "We're committed to working alongside the provider network to deliver better care at a lower cost to MassHealth members," said Jeffrey Siegal, C eo of Geriatric Medi- cal Supply. While the general idea of the contract appears better than other alternatives, e strella and other stakeholders still have a number of questions, including the implica- tions, if any, of providers choosing to buy incontinence products from other distribu- tors and manufacturers. "What if they're audited?" e strella asked. "How do they prove that these other distrib- utors have met the same quality standards that the preferred supplier, Geriatric Medical, has? There are still some unknowns." hme 'Unfeasible if Medicare sticks to business as usual' Round 2019 CMS upends oxygen CMN Trump mostly falls short in first year, respondents say anything to do with reforming Medicare's competitive bidding program. "I support this administration, but (the Depart- ment of Health and Human Ser- vices) needs to fix rural reim- b u r s e m e n t , " wrote Bob Forbes of Advantage Home o xygen in Dubois, Pa. "I've already watched one local (company) close and everyone else has downsized to the point of (threatening) patient safety." Fifty-one percent of respon- dents said the first year of a Trump administration has not had a positive impact on their businesses. For the 49% respondents who reported Trump has had a posi- tive impact, many credited tax reform. Massachusetts transitions to preferred supplier hme NEWS POLL Bachenheimer O x y G E N s e e pa g e 4 T R u m p s e e pa g e 4

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