In Need of an O2 Fix

Over the past 15 months, questions about the impending oxygen cap have been expressed time and again on Capitol Hill and at the Centers for Medicare and Medicaid Services by the American Association for Homecare. Yet no one could have anticipated how austere and unworkable CMS’ recently published guidance would be.

The Association is focused on this issue and has been pulling out all the stops. We firmly believe that it is bad policy to cap any Medicare benefit while there exists a medical need for services. Furthermore, the guidance Medicare recently provided on home oxygen therapy to seniors is alarming and wholly inadequate.

So AAHomecare is taking a two-pronged approach to this critical issue. First, we continue to try to work with CMS while at the same time laying the foundation to seek a long-term solution.

Members of AAHomecare’s Regulatory Committee met with CMS staff to discuss policy related to the 36-month rental cap prior to the agency’s publishing the 2009 Physician Fee Schedule final rule. The meeting was a follow-up to address questions about the implementation of oxygen policy contained in the Deficit Reduction Act of 2005 and the Medicare Improvements for Patients and Providers Act of 2008.

But in the final days of October, CMS released new guidance that addressed home oxygen provider responsibilities and coverage policy after the 36-month rental cap, including for oxygen contents, maintenance, service, supplies, accessories and repairs; treatment of traveling patients; and useful lifetime policy.

These regulations diminished the important role that home care providers play in the provision of care to Medicare patients on home oxygen by focusing on the equipment and not accounting for the required range of services and the realities of providing quality oxygen therapy to beneficiaries who suffer from COPD and other lung diseases.

Specifically, AAHomecare is alarmed about:

• the requirement that oxygen providers are responsible for the provision of oxygen therapy even when the patient moves out of a provider’s service area;
• the treatment of routine maintenance and service of the oxygen system to ensure that it is working at optimal performance levels;
• no recognition of costs associated with visiting patients who require episodes of unscheduled emergency services; and
• no payment for the oxygen supplies that are required to keep the patient healthy and keep the equipment working properly once the 36-month cap on oxygen becomes effective.

The agency has indicated it will provide additional guidance in the coming months related to implementation of these policy changes. But in the interim, we need to raise these concerns and seek solutions at the earliest opportunity.

So, now is the time to act. AAHomecare is sorting through these problems. We will work to ensure patients are well served while protecting the interests of home oxygen providers. To achieve those outcomes, AAHomecare recommends that providers and patients report problems and concerns to their members of Congress as the 36-month cap approaches. Make lawmakers aware of constituents who are nearing the rental cap and are experiencing issues finding new home oxygen providers.

Also, express concerns about how payments will be made and what will be covered once the 36-month rental cap takes effect. If we do not build the case for change, our issues could get drowned out by the multitude of issues that will arise with a new Congress and presidential administration.

The Association will also be responding to the open comment period for the 2009 Physician Fee Schedule final rule concerning oxygen. Comments on the oxygen regulation are due by Dec. 29, 2008.

Elected representatives in Washington cannot act during their next session unless they understand the gravity of the problems. I urge you to contact AAHomecare as problems occur so that we can document the issues and share them with decision makers as we continue to work toward an “O2 fix.”

Tyler J. Wilson is president and CEO of the American Association for Homecare, headquartered in Arlington, Va. You can reach him at [email protected]. For more information on critical home care issues, visit the association’s Web site at www.aahomecare.org.