AAHomecare Asks CMS for Clarification on DRA
ALEXANDRIA, Va.–In an April 20 letter addressed to Herb Kuhn,
director of CMS’ Center for Medicare Management, the American
Association for Homecare has asked for clarification on the oxygen
and DME rental cap provisions in the Deficit Reduction Act.
The association is concerned about a number of issues involving
implementation of the DRA–signed into law on Feb. 8–which will
cap Medicare rental of home oxygen equipment at 36 months and
transfer the title to the beneficiary, as well as eliminate the cap
rental option for DME (see HomeCare
Monday, Jan. 9).
“AAHomecare understands that these new payment methodologies do
not take effect immediately. However, their impact on our members’
operations is immediate because they must begin to structure their
operations to respond to the changes,” the letter said. “Moreover,
providers must plan now for their implementation in order to ensure
a smooth transition for Medicare beneficiaries.”
The letter included the following 33 questions addressing
medical necessity and documentation, reimbursement, service and
maintenance and other issues:
- Will current regulations defining “continuous use” for capped
rental DME remain unchanged? - How will CMS define “continuous use” for oxygen equipment? What
will constitute a break in service so that a new period of
continuous use commences for beneficiaries on oxygen? - When a beneficiary owns his or her oxygen equipment, will
Medicare pay for new equipment on the basis of a change in
condition? Does the change in equipment begin a new period of
continuous use? - Will CMS issue regulations to address the issues raised in
questions 1 and 2 above? If so, what is the projected timeline for
a proposed rule? - If new technology becomes available that is medically
appropriate and has the potential to improve health outcomes, will
the beneficiary be responsible for paying for the new equipment
(assuming there has been no change in condition)? - How will CMS define “oxygen” after the 36-month period of
continuous use ends? How will the medical necessity documentation
for oxygen change? Will lifetime CMNs be valid for beneficiaries
who own their own equipment? - Will beneficiaries who have both a concentrator and stationary
liquid or a concentrator and a portable concentrator be responsible
for purchasing one of the two systems after 36 months? - How will CMS pay for refills on an oxygen cylinder? Will the
payment amount differ between patients who require more refills
because they have a greater need for mobility or a higher
prescribed liter flow? - How will CMS take into consideration those patients who have a
concentrator and a liquid system, where the liquid system is being
primarily used for ambulatory/portable requirements? Will the
Medicare program pay for additional portable cylinders after the
36-month rental period, or will it be the beneficiary’s
responsibility to purchase these items? - Will the beneficiary be responsible for purchasing supplies
such as cannulas and tubing for their oxygen equipment or other
items such as humidifiers? - May providers charge beneficiaries a rental or purchase for a
back-up emergency cylinder that is not used to meet the patient’s
portable oxygen needs? These units would be used solely in the
event of an emergency such as a power outage, a natural disaster,
or a malfunction of the beneficiary’s primary equipment. Will
Medicare pay for the contents once these cylinders are used? - Will the payment amount differ based on different oxygen
technologies that may be more or less costly for the provider to
furnish? - Providers may be unable to service a patient-owned portable
oxygen cylinder that they did not furnish. Will the beneficiary be
responsible for purchasing a new oxygen cylinder under these
circumstances? - Will rental months at a beneficiary’s second residence apply
towards the 36 months of continuous use? If so, which provider is
responsible for transferring title to the beneficiary (i.e., the
primary provider, or the provider at the second residence)?
Similarly, if a beneficiary moves during the period of continuous
use, which provider is responsible for transferring title (the new
provider or the original provider)? - For short-term travel, the beneficiary pays for the oxygen
out-of-pocket and the primary provider may reimburse all or a part
of those costs. AAHomecare anticipates that this rule will not
change for beneficiaries who own their oxygen equipment. That is,
the beneficiary will continue to be responsible for arranging and
paying for travel oxygen. With respect to the period of continuous
use, please confirm that our understanding is correct. After title
to the equipment transfers, will Medicare pay the beneficiary
directly for short-term travel oxygen? - Will the beneficiary be responsible to pay charges for pick up
and delivery of oxygen refills after title to oxygen equipment
transfers to the beneficiary? If not, what data does CMS propose to
use to arrive at an appropriate payment amount for pick up and
delivery charges? - For beneficiary-owned equipment that requires servicing, will
Medicare pay pick up and delivery charges? If so, what data will
CMS use to arrive at an appropriate payment amount for pick up and
delivery charges? - Does CMS intend to apply any of the billing rules that applied
to capped rental equipment to rent-to-purchase DME? A purchase
option letter is unnecessary inasmuch as the beneficiary no longer
has the “option” to purchase the equipment. Consequently, we see no
need to use the BP, BR, or BU modifiers in the 11th, 12th and 13th
rental months. - How will CMS define the useful of life of oxygen
equipment? - If oxygen equipment is “irreparably damaged” after title has
transferred to the beneficiary, but before the end of the
equipment’s “useful life,” will Medicare pay for new equipment? If
so, will this commence a new period of “continuous use,” or will
CMS pay a lump sum amount for the new equipment? - Does CMS have a timeline for issuing regulations that address
questions 17 and 18 above? - Oxygen cylinders must undergo hydrostatic testing and other
checks periodically. Though technically these tests are not
“repairs,” will they be reimbursed as repairs to account for the
more extensive service they involve? - Will the Medicare program pay for emergency service calls for
beneficiary-owned equipment that is still under warranty? If not,
can providers contract with beneficiaries to provide on-call
services for patient owned equipment? - If the manufacturer of equipment that is under warranty is no
longer in business, will the beneficiary be responsible for paying
for replacement parts? If the provider who furnished the equipment
to the beneficiary is no longer in business, who is responsible for
the repairs? - How will providers document that the maintenance and service
they performed on oxygen equipment were reasonable and necessary?
Will CMS require different documentation depending on whether the
provider repairs the equipment it furnished or equipment furnished
by another provider? - Will CMS issue temporary HCPCS codes to identify the service,
maintenance and repairs for oxygen equipment, or will providers
have to apply for the codes? - How will providers be reimbursed for service or maintenance to
non-covered oxygen equipment such as conserving devices or oxygen
titrating devices? Will providers bill the beneficiary for these
services? - Will CMS issue temporary HCPCS codes to identify service and
maintenance repairs and parts for equipment in the capped rental
category, such as motor and hand controls for a bed, or will
providers have to apply for the codes? - Will the requirements of the DRA apply retroactively to January
1, 2006, regardless of whether the need for systems changes result
in administrative delays in implementation? - Will CMS require providers to transfer title to beneficiaries
who have unpaid deductible and coinsurance balances? - After title to the oxygen equipment transfers to the
beneficiary, will beneficiaries be responsible for paying for
clinical assessments required under state law? Will the beneficiary
be responsible for paying for respiratory assessment ordered by the
physician? - Please confirm that parenteral and enteral pumps are not
subject to the rent-to-purchase methodology established under the
DRA. - How will providers be reimbursed if beneficiaries begin to use
oxygen or capped rental equipment under a Medicare Advantage plan?
Will CMS begin a new period of continuous use each time the
beneficiary has a payer change in or out of traditional
Medicare?
OUR DIGITAL PARTNERS