Accreditation Proposals Raise Eyebrows

WASHINGTON — On Thursday, the Ways and Means Committee
voted 23-18, mostly along party lines, in favor of the House health
care reform bill, and the Labor and Education and Energy and
Commerce committees were also deep in their consideration of the
plan.

Among a host of dramatic changes to the nation’s health care
system, the landmark legislation would create a national health
exchange, penalize those who do not buy health insurance and levy a
surtax on the country’s wealthy to help pay for the overhaul.

Called
America’s Affordable Health Choices Act of 2009 (H.R. 3200),
the House bill would also reshape Medicare, with several provisions
that affect DME.

While some of those provisions were outlined in a “discussion
draft” of the bill released in June — including elimination
of the first-month purchase option for power wheelchairs —
there were also a few surprises, among them changes to the DMEPOS
accreditation program.

According to the bill, any provider that submits an application
for accreditation before Aug. 1, 2009, would be deemed as meeting
the applicable standards and requirements unless its accreditor
took action (denied accreditation).

The bill would also exempt some pharmacies — those that
are Part B suppliers of diabetic supplies, canes and crutches
— from the DMEPOS accreditation mandate, although pharmacies
that provide other DME items would still be subject to the
requirement.

The proposed changes have raised the eyebrows of some
accreditation experts.

“That was a shocker,” said Mary Nicholas, executive director of
Waterloo, Iowa-based accreditor HQAA, referring to the proposal that
applicants who haven’t completed the process could be considered as
meeting accreditation standards. “It seems so counter-productive to
the goals the industry has had, which are to step up quality,
improve business practices and eliminate fraud and abuse.

“The implication, as I read it, allows everyone to keep their
supplier numbers unless and up until the point they are denied
accreditation,” she continued. “Those companies the industry is
trying to eliminate — those that are fraudulent or purposely
abusive of the system — can apply with an accreditor by Aug.
1 and can be deemed as meeting the standards?

“I’m perplexed,” Nicholas said. “I don’t understand how that
could be implemented.”

She’s also wondering about the possible exemption for
pharmacists who do business in diabetic supplies, crutches and
canes.

After details of the House bill came out, Nicholas said, “I
pondered that all night. How many pharmacists are there that just
do those three items? What happens to pharmacies that also do wound
care and ostomy? Does that mean they would quit doing ostomy or
other Part B items to avoid accreditation? What will that do to
access? And what about pharmacists who want to participate in
competitive bidding or be subcontractors?”

Pharmacy groups — including the American Pharmacists
Association, National Association of Chain Drug Stores, National
Community Pharmacists Association and the National Alliance of
State Pharmacy Associations — have been pushing Congress for
an exemption, arguing that pharmacists are the only licensed
medical professionals who must meet CMS’ accreditation
requirements.

But so far, CMS has said all providers who want to continue
serving Medicare beneficiaries, whether they participate in
competitive bidding or not, must be accredited by the upcoming Oct.
1 deadline.

If the proposed pharmacist exemption becomes law, Nicholas said,
“There will be a lot of questions. There would be several sets of
conflicting guidelines that may confuse the industry even
more.”

Mary Ellen Conway, president of Capital Healthcare
Group, agreed. Such an exemption “is going to infuriate the
thousands of pharmacies, large and single-site, who have been
compliant with this requirement,” the Bethesda, Md.-based
accreditation consultant said. “It is surprising that this
‘reprieve’ for pharmacies may occur so close to the deadline.

“Of course,” she pointed out, “there are payers other than
Medicare that still require accreditation, including many state
Medicaid programs.”

Survey Crunch Time

Conway also has other concerns about the accreditation program, she
said, assuming the October deadline stands.

“There are too many people in the pipeline, and the
subcontractor accreditation requirement is making it worse,” Conway
said.

Many of CMS’ accreditation organizations were already fully
scheduled for provider surveys during the summer, she noted, but
now they’re being swamped with calls about CMS’ requirement that
providers’ subcontractors — those who deal with equipment
delivery and set-up, among other things — must also be
accredited.

“It takes at least four to six months to go through the process,
and there is already a huge backlog of people trying to get
through,” she said.

In addition, Conway said she is worried about providers who are
only now beginning accreditation.

She believes “a lot of people signing up now knew they wouldn’t
meet the deadline. I think many of them thought they might miss a
few months until they got through the process, but then they could
start billing again.” She doesn’t think providers understood that
if their supplier numbers are revoked Oct. 1 — which CMS has
said would happen if a provider is not accredited — they
won’t be able to re-enroll in Medicare for a year.

“I think that’s frightening,” Conway said. If providers have cut
it too close and their accreditation won’t be completed, she
cautioned, “they need to voluntarily terminate their number before
the deadline, and in plenty of time for the change to get
processed.

“My advice is that they properly change their 855S enrollment
form and terminate their number themselves rather than getting
revoked on Oct. 1. Then they have the option of coming back in when
they are ready.”

Both Nicholas and Conway, however, said with the unexpected
accreditation changes included in the House bill, anything could
happen. The question is whether the provisions, if passed, would
become law and be implemented before the CMS deadline.

“It’s like a snowball fight that doesn’t end,” Nicholas said.
“So many things are being thrown at providers, and the expectation
is that they’re catching all the balls.”