Major 2013 Amendments and Their Impact on the HME Industry’s Future

MPP on Capitol Hill—The industry made tremendous progress in 2013 in garnering the support of 160 Representatives (37 percent of the House) signing on in support of H.R. 1717, the Medicare DMEPOS Market Pricing Program Act. At press time, we were vigorously working to get this bill attached to a moving piece of legislation, although it is very possible that a legislative vehicle may not occur until early in 2014. This means you should still be informing your Members of Congress about the ill effects of this Medicare bidding program and that Congress needs to step in and fix this flawed program. CRT Separate Benefit Category—The complex rehab technology (CRT) community was successful in getting bills introduced in both the House and Senate that would extricate CRT from the DME benefit and create a separate CRT benefit within the Medicare program. The House bill, H.R. 942, has 84 co-sponsors, and the Senate bill, S. 948, has five co-sponsors. At press time, Sen. Charles Schumer (D-NY) was trying to get this bill amended to the Senate’s ?physician payment reform package. On the state level, this past spring, Washington became the first state to pass a law recognizing CRT as a separate benefit within its state Medicaid program. This change will be effective January 2014. PA PMD Program—Entering its second year of implementation, the Medicare prior authorization (PA) demonstration project for power mobility devices (PMDs) has been operating in seven states and has received generally positive reviews from most mobility providers. The demonstration is scheduled to last three years, through August 2015. After that, we expect the Centers for Medicare and Medicaid Services (CMS) to expand the PA program nationwide. Providers support the program, because they receive a positive or negative medical necessity determination from the DMAC prior to providing the PMD services. Medicare DME Face-to-Face Rule—July 1 was the effective date of the new Medicare DME Face-to-Face regulation for many DME items. Since then, CMS has issued several advisories delaying the enforcement date of this rule. Unfortunately, tremendous confusion still remains regarding whether HME providers are responsible for compliance with this new rule as of July 1, despite CMS’s official statement that it has delayed the enforcement date to a date that will be announced in 2014. Most recently, CMS stated that the written order prior to delivery is not delayed and that the only delay in enforcement is for the actual face-to-face encounter itself. Oxygen Policy Change—In August of this year, CMS announced a significant Medicare oxygen policy change through its Medicare email newsletter. Responding to the apparently large number of beneficiaries who have been abandoned by providers who have gone out of business, Medicare announced that a new provider starting to service patients who have been abandoned by another provider would be able to start the 36-month oxygen rental cap at month one, rather than being required to accept more limited rental months. We are awaiting Medicare clarification regarding the appropriate documentation that the new oxygen provider must obtain. Final Rule Reclassifying 78 Codes to Capped Rental Payment Category—In November, CMS finalized its fundamentally flawed proposal to reclassify 78 HCPCS codes from the purchase to the capped rental payment category. One of the most problematic issues is that tilt-in-space chairs (E1161) will be capped rental instead of purchase items. The effective date for this new rule will vary based on whether the item is included in either, both, or neither of the rounds of competitive bidding. The earliest effective date is April 1, 2014 for items not included in either round of competitive bidding (including E1161). If the item is included in one or both of the bidding rounds, the effective date will be either July 1, 2016 or Jan. 1, 2017. Implementation of Round 2 and Round 1 Recompete of Competitive Bidding—Last, but certainly not least, on July 1, CMS began implementation of the Medicare DME bidding program in an additional 91 metropolitan areas. In fall of 2013, CMS announced the bid prices and contractors for the Round 1 recompete that begins Jan. 1, 2014. CMS largely ignores the many beneficiary complaints of access and quality, and many providers continue to struggle.