HOPP Act Would Repeal 36-Month Oxygen Cap

WASHINGTON–Yesterday, Reps. Tom Price, R-Ga., and Heath Shuler,
D-N.C., introduced legislation to repeal the 36-month rental cap on
home oxygen therapy. The Home Oxygen Patient Protection (HOPP) Act
of 2009 (H.R. 2373) would restore payments for the period of
medical need.
 
In a joint statement, Price and Shuler noted the existing law
“jeopardizes the patient-provider relationship for home
oxygen care after 36 months under Medicare.”
 
Price, a physician, has twice before introduced legislation to
repeal the oxygen cap following the Deficit Reduction Act’s
limit on rental payments, which took effect Jan. 1. (See “Price
Reintroduces Bill to Repeal O2 Cap,” Jan. 29, 2007.) In
Congress’ 110th session, the HOPP Act (then known as H.R.
621), garnered 143 cosponsors.
 
Shuler has championed the industry’s fight against
competitive bidding, calling for an end to the program in a
congressional hearing earlier this year. (See “Shuler
Calls on Congress to End Competitive Bidding,” Feb.
12.)
 
In a “Dear Colleague” letter in December, which they
titled “Help Protect Home Oxygen Suppliers,” the representatives
noted the oxygen cap was set to coincide with the 9.5 percent DME
reimbursement cut for product categories including oxygen, which
also took effect Jan. 1. And in a Feb. 9 letter addressed to House
leaders, Price and Shuler again asked colleagues for help in urging
CMS to set adequate payments for oxygen after the cap period.
 
That letter, also signed by Reps. Mike Ross, D- Ark., and Jo Ann
Emerson, R-Mo., pointed out that home oxygen “is a critical,
life-sustaining medical treatment” and said both patients and
providers had already begun to see “the detrimental
effects” of the new oxygen rules.
 
Prior to the DRA, Medicare paid for home oxygen through a bundled
payment that included the cost of equipment, services, repairs and
supplies as long as the therapy was medically necessary. But a
provision in the DRA capped payments at 36 months, and in
subsequent post-cap payment rules, CMS said providers will be
reimbursed for only one 30-minute routine maintenance visit every
six months after the oxygen equipment has capped out. They will
also be required to maintain and service the equipment for the
remainder of its “reasonable life” (generally five years under
Medicare guidelines) even if the patient moves. As well, they will
not be reimbursed for emergency calls or replacement items such as
masks.
 
“Home oxygen providers are more than just suppliers of
equipment, they are also front-line caregivers,” the
Price-Shuler letter read. “They educate patients on the
proper use of their equipment, answer patients’ questions, make
repairs and adjustments, and ensure that patients are receiving the
prescribed amount of oxygen. These providers are on the first line
of care for Medicare beneficiaries who require home oxygen therapy.
They take calls at all hours and in rural areas drive long
distances to make sure that their patients receive the care they
need. Without reimbursements for these visits, suppliers will not
be able to afford to provide the current level of care for many of
these oxygen patients.”
 
The Georgia Association of Medical Equipment Services and the North
Carolina Association for Medical Equipment Services worked with
Price and Shuler in developing the new bill. 
 
“We believe a direct repeal of the oxygen cap is what’s
best for Medicare patients in Georgia,” said GAMES Executive
Director Teresa Tatum. “The HOPP Act offers a simple,
common-sense solution to address the immediate risk to home oxygen
patients as well as the providers who care for them.
 
“As a physician, [Rep. Price] understands when it comes to
health care, patients must come first,” Tatum continued.
“Now it is time for all providers–large and small–to rally
together in support of this legislation. Washington needs to hear
our collective voice as thousands of us make calls and send emails
requesting our members of Congress cosign this important
legislation.”
 
The sentiment was echoed this morning by a number of HME
organizations, including the American Association for Homecare, the
National Association of Independent Medical Equipment Suppliers,
members services group VGM and the newly formed Committee to Save
Independent HME Suppliers (CSI:HME).
 
“All providers are urged to contact their House members and
ask that they cosponsor H.R. 2373,” a VGM legislative alert
said, noting that Democratic representatives should contact Erin
Doty in Rep. Shuler’s office at 202/225-6401; and Republican
representatives should contact Emily Henehan in Rep. Price’s
office at 202/225-4501. 
 
The full text of the HOPP Act should be available shortly at
http://thomas.loc.gov.