Standards No. 7 and 9: What the Changes Could Mean for You

By all accounts, the effects of CMS’ proposed revision and
expansion of supplier standards for DMEPOS will be far-reaching. In
a special series for HomeCare Monday leading up to the March 25
deadline for comments, health care attorney Neil B. Caesar,
president of the Health Law Center, Greenville, S.C., will help
provide clarification and insight on several provisions of the
draft rule. This week, Caesar’s comments are directed to an
expansion of existing standard No. 7 dealing with physical
facilities and signage, and to standard No. 9 regarding the
business telephone.

Standard No. 7 currently requires that a provider maintain a
physical facility at an appropriate location and that the facility
contain space for storing various types of business records. CMS
proposes several revisions to this standard. First, the agency
wants to require that suppliers maintain business records for seven
years after the claim has been paid. This requirement is not
necessarily burdensome, but it does suggest that suppliers need a
formal, well-organized system for records storage and access.

The second revision requires the supplier location to be
accessible to beneficiaries and CMS during posted business hours.
Further, there must be a sign identifying the company that is
permanent and durable, and that is visible at the main entrance to
the public including customers using wheelchairs. CMS states that a
supplier whose business is located within a building complex must
have its sign visible at the main entrance. This latter requirement
could be a problem for providers in multiple-tenant buildings
because landlords often have strict signage rules that may conflict
with CMS’ proposed revision.

CMS also clarifies that the business must be staffed during the
posted hours of operation, regardless of whether visitors are
coming. This is not problematic on its own. But in combination with
[a new standard CMS has proposed that] requires suppliers to be
open a minimum of 30 business hours weekly, this standard may
severely limit the ability of one- or two-person HME companies to
staff the office and handle deliveries within a normal business
week.

CMS also clarifies that these proposed revisions apply to
“closed door” companies “such as pharmacies, or suppliers providing
services only to beneficiaries residing in a nursing home.”

Under this standard revision, CMS is also seeking comments about
whether to impose a minimum square footage requirement. Again, such
a requirement raises questions of fairness for small suppliers and
closed-door companies.

CMS emphasized in its comments a supplier that is not open
during posted hours when NSC inspectors arrive will have its
supplier number yanked. It is unclear whether CMS would take this
strict approach after only one missed visit, but this newly
emphasized strictness is reiterated in CMS’ comments about standard
No. 8, which deals with on-site inspections and accessibility.

CMS’ proposed revision to standard No. 9 deals with the business
telephone. It currently requires that a supplier maintain a
business phone under the business’ name for use by beneficiaries.
The standard currently emphasizes that a supplier may not use
alternate means of communication as the primary business telephone,
such as beepers, answering services, pagers, fax machines, car
phones or answering machines.

CMS now proposes to revise this standard to exclude cell phones
and beepers altogether as a method of receiving calls, and further
seeks to prohibit all “call forwarding” from beneficiaries or the
public to a cell phone or beeper during posted hours of operation.
Apparently, such call forwarding would be allowed outside of posted
hours.

This new requirement tracks CMS’ seeming insensitivity to small
suppliers, which is reflected throughout these proposed revisions,
because it makes it quite difficult for a supplier to make
deliveries during business hours while still remaining accessible
to the public.

Clearly, CMS’ intent reflected in these standards is that every
supplier should operate like a retail shop. Someone should always
be sitting behind the counter answering the telephone and awaiting
visitors. In one- or two-man operations, deliveries, etc., may have
to wait until the close of business.

In light of the primary focus of Medicare HME providers on
servicing customers who cannot easily and routinely visit their
stores, this emphasis on the retail location may be excessive.

View the proposed supplier standards rule.

Comments on the proposed supplier standards are due March 25,
2008. Comments may be submitted online at www.regulations.gov. Follow the instructions
under the “Comment or Submission” tab and enter the file code
CMS-6036-P.