Making It Happen

CMS’ final rule implementing the Deficit Reduction Act’s oxygen and capped rental provisions was a significant improvement compared to its proposed version. In addition, CMS’ announcement of revised fees for power wheelchairs was a huge step in the right direction.

While Medicare’s oxygen, capped rental and power wheelchair worlds are far from perfect, they are far better than they could have been. What does this mean? Solid data and consumer advocacy really can make the difference between bad policy that can devastate consumer access and policy that will ensure appropriate access.

The DRA provisions require Medicare monthly payment for oxygen equipment to be capped at 36 months. Title of the oxygen equipment will transfer from the supplier to the beneficiary at that time. In implementing the final oxygen rule, CMS clarified that effective Jan. 1, 2007, payment will be based on the specific equipment provided; that is, payment levels will vary based on the specific class of oxygen technology. But for purposes of counting toward the 36-month cap, Jan. 1, 2006, is the earliest month for beneficiaries who have been on home oxygen during 2006.

Under the final rule, CMS established separate classes and monthly payment amounts for both stationary and portable oxygen contents that must be delivered for beneficiary-owned liquid or gaseous oxygen equipment. CMS also established a new class and monthly payment for new technology such as portable oxygen transfilling equipment and portable concentrators. A higher portable add-on payment will be allowed for systems that eliminate the need for delivery and refilling of oxygen contents for portable systems.

To create the separate classes, CMS is using its authority established by the Balanced Budget Act of 1997; this authority requires payment changes to be budget-neutral. That means that Medicare’s total spending for all modalities of oxygen equipment, including contents, must be the same under the changed payment rates as it would be without these payment changes.

To achieve budget neutrality, CMS will modify the respective payment rates for different oxygen technologies or classes to ensure budget neutrality on an annual basis.

Our industry made persuasive arguments to CMS that the payment levels in its August 2006 proposed rule were not, in fact, budget-neutral. As a result, CMS increased the monthly allowable for stationary equipment by about $20, and also the portable fees. The final rule states that payment for traditional technology, such as an oxygen concentrator and delivery of portable tanks, will be about $230 per month for months one through 36.

To help compensate providers for the higher capital investment new technology requires, and to provide incentives for suppliers to provide this new technology, Medicare will provide an approximate $20 premium in months one through 36 if the provider furnishes new technology that CMS calls “oxygen generating portable equipment” or a portable oxygen concentrator, resulting in a monthly payment of about $250 for months one through 36.

On the power wheelchair front, CMS issued a last-minute announcement that many of the fees it had released earlier, particularly those for Group 3 products, were being increased effective November 15. The original fees, issued October 2, would undoubtedly have resulted in serious access issues.

That fact was borne out by a series of national, state and local efforts by organizations representing affected consumers, and many individual consumers on their own. These consumers took the time to write letters to their local newspapers and to write and meet with their members of Congress to explain firsthand the impact the October 2 fees would have on their lives.

Over about six weeks, more than 1,000 stories in media outlets, including several hundred newspapers, were generated. The access problem was real, and it obviously hit a nerve.

Lessons from these two issues? Hard facts and data, and consumers at the forefront of the message. These need to be the strategies our industry uses on a consistent basis to ensure that policymakers ensure consumer access.

A specialist in health care legislation, regulations and government relations, Cara C. Bachenheimer is vice president, government relations, for Invacare Corp., Elyria, Ohio. Bachenheimer previously worked at the law firm of Epstein, Becker & Green in Washington, D.C., and at the American Association for Homecare and the Health Industry Distributors Association. You can reach her by phone at 440/329-6226 or by e-mail at [email protected].