Cap Concerns

On Oct. 30, CMS released initial guidance — that both HME providers and other industry advocates had been requesting for months — regarding the many ambiguities surrounding the 36-month oxygen rental cap set to take effect Jan. 1.

Basically, the new rules state that the provider that furnishes the equipment during the 36-month period must continue to do so after the cap period during any period of medical need for the remainder of the useful life of the equipment — even if the beneficiary relocates outside the provider’s service area.

In this case, the provider must make arrangements for the beneficiary to receive the oxygen services at his/her new location. And, according to the rule, this responsibility cannot be transferred to another supplier.

After the five-year useful life, the beneficiary can choose to obtain new equipment, and then a new 36-month rental period will begin.

So the provider is responsible for — but will not be paid for — maintenance, servicing and repair of oxygen equipment for an additional two years past the cap.

For 2009 only, Medicare will pay for 30 minutes of labor once every six months for routine maintenance and service actually performed on oxygen concentrators or transfilling equipment in the patient’s home. No payment is available for repair or servicing of gaseous or liquid oxygen equipment.

“I think the cap sounded great on paper to legislators and CMS, but very few people outside of the HME providers and the patients appreciated the complexities associated with the provision of 24-hour home oxygen therapy,” says Joe Lewarski, vice president, respiratory group, Invacare Corp.

Indeed, industry associations including the American Association for Homecare, the Accredited Medical Equipment Providers of America and the National Association of Independent Medical Equipment Suppliers are all encouraging providers to comment on the rules.

According to Dan Easley, president and CEO, Inspired Technologies, providers must get their patients involved.

“It is a matter of patients having the same amount of influence in this discussion with CMS [as they did with the delay of competitive bidding]. Also, in getting competitive bidding delayed, the fantastic support from Congress to challenge CMS policies and call them on the carpet to answer the practical points about it and then act was encouraging,” he says.

“There was great unanimity within the industry that got Congress to see the patient’s aspect. It is much more powerful when you can describe it in terms of how it affects the patient. Strategically, we need to continue to work with Congress and CMS to help them understand that this is a service business and not equipment rental.”