Cure for Red Tape Blues

Rules and regulations often need clarification to prevent confusion — or unnecessary burdens — for the HME community. Fortunately, volunteers on AAHomecare’s councils and committees donate generous amounts of their time to analyze and respond to a wide array of thorny regulatory matters.

Over the past year, these volunteers have taken on a long list of challenges:

• Competitive biddingSerious concerns were expressed by providers who ran into problems submitting bids for the first round of the competitive bidding program. The Association teamed up with consumer and patient groups in Washington to garner congressional support for an extension in the bidding window. Congressional letters asked CMS to answer some of the critical questions from providers before moving forward with the program. The efforts of AAHomecare volunteers, in concert with industry groups, consumer groups and members of Congress, led to a significant extension in the original 60-day bid window in 2007. However, the extension did not alleviate all of the concerns. In order to field queries and serve as a mediator for members with CMS, our councils and committees collected questions and concerns from the industry regarding problems with the bidding program and sent them to CMS. We hope that raising these questions will help ensure greater transparency and fairness in the bidding system: Will CMS outline how the pivotal bid is established so that the public will have an opportunity to review it? How can additional regulatory initiatives be factored into an established bid rate once the bid has been set? What steps is CMS taking to better educate the competitive bidding implementation contractor staff? What are the roles and responsibilities of the ombudsman?
• Assistive Technology Practitioner (ATP) RequirementsDME Program Safety Contractor medical directors accepted a request from AAHomecare’s Rehab and Assistive Technology Council to revise the power mobility devices local coverage determination. In a letter to the Association, the medical directors stated: “The DME PSC medical directors have decided to accept your request to revise the Power Mobility Devices LCD and eliminate the requirement that patients receiving rehab power wheelchairs on or after April 1, 2008, be evaluated by a RESNA-certified Assistive Technology Practitioner. “The current requirement will remain in place — i.e., the patient must have ‘a specialty evaluation that was performed by a licensed/certified medical professional, such as a PT or OT, or physician who has specific training and experience in rehabilitation wheelchair evaluations and that documents the medical necessity for the wheelchair and its special features’. “In addition, for claims with dates of service on or after April 1, 2008, we will implement the requirement that the wheelchair must be provided by a supplier that employs a RESNA-certified Assistive Technology Supplier (ATS) or Assistive Technology Practitioner (ATP) who specializes in wheelchairs and who has direct, in-person involvement in the wheelchair selection for the patient.”
• Other regulatory issuesAdditional issues tackled by the AAHomecare Regulatory Committee include questions about oxygen policy changes in the Deficit Reduction Act of 2005, access to patient data in Medicare’s common working files, revised quality standards, official standards of conduct, power mobility device initiatives, and recovery audit contractor activities.

The Regulatory Committee has also been monitoring the Office of Inspector General 2008 Work Plan, which has several studies planned for this year, including DME payments for beneficiaries who receive home health services, payment suspensions for medical equipment suppliers, Medicare payments for power wheelchairs and changes in average sales prices for Part B drugs.

The AAHomecare volunteer committees and councils work throughout the year to provide valuable analysis and counsel. This is one of the best cures for the regulatory blues that government red tape tends to trigger.

Tyler J. Wilson is president and CEO of the American Association for Homecare, Alexandria, Va. He may be reached by e-mail at [email protected]. For more information about the association, visit www.aahomecare.org.