Bill Would Exempt Pharmacists from Accreditation

WASHINGTON — Calling Medicare’s accreditation requirement
“unnecessary and unfair,” Reps. Marion Berry, D-Ark., and Jerry
Moran, R-Kan., introduced a bill on Wednesday that would exempt
pharmacists.

The bill comes just days before CMS’ advised Jan. 31
accreditation sign-up deadline. Applying by that date, the agency
has said, will ensure providers get through the process in time to
meet the agency’s mandatory Sept. 30 deadline, by which all DMEPOS
providers must be accredited in order to bill Medicare.

CMS has exempted some “eligible professionals,” including
physicians, from the requirement. In addition, “other persons,”
including orthotists, prosthetists, opticians and audiologists, are
also exempt. The proposed legislation would add pharmacists to the
list.

In announcing the bill (H.R. 616), Berry pointed out that
community pharmacists “are the only licensed medical professionals
that must meet new CMS accreditation requirements as suppliers of
DMEPOS.”

“In rural areas … community pharmacists are often the only
medical professionals available who can supply this vital equipment
to patients,” he said. “The current law threatens the ability of
patients to get the supplies and care they must have to stay
healthy. This bill will ensure Medicare patients have access to the
supplies they need while also helping community pharmacies keep
their doors open.”

Pharmacy groups, including the American Pharmacists
Association, Food
Marketing Institute, National Association of Chain Drug Stores, National Community
Pharmacists Association and the National Alliance of State Pharmacy
Associations, applauded the bill.

“Not only are there significant costs associated with the
accreditation process that can create huge financial barriers for
pharmacies and pharmacists that are already state-licensed, more
importantly, the process poses a threat to patients’ access to DME
supplies and counseling from their pharmacist,” according to a
release from the groups.

But accreditation stakeholders were not as enthusiastic about
the bill.

“It’s mixed good and bad from this perspective,” said Carmen
Catizone, executive director of the National Association of Boards of Pharmacy in
Mount Prospect, Ill., which accredits pharmacies. “We didn’t really
believe this rule was needed for pharmacists or pharmacies to begin
with. We thought it was a bit of overkill because they are already
licensed.

“Now that we are accrediting,” he continued, “we have seen some
benefits from accreditation, and we have been able to detect a bit
of fraud that wouldn’t have been detected if accreditation hadn’t
been in place.”

He said while some independent pharmacies have complained that
the accreditation price tag is too high, others have said the
process has helped them do business better. Indeed, he said,
accreditation — and NABP has accredited about 10,000
pharmacies, “every major chain except Wal-mart,” Catizone said
— has helped raise pharmacies to higher standards.

“Hopefully, the right thing to do is to keep accreditation in
place and if it is not working, then get rid of it in a few years,”
he said.

Sandra Canally, president of accrediting body The Compliance
Team, Spring House, Pa., said she does not support exempting
pharmacies — or anyone else.

“To exempt these folks is not a good decision,” said Canally,
noting her company has already accredited hundreds of pharmacies.
“The whole point of the Medicare Modernization Act [which mandated
accreditation] was not only to prevent fraud and abuse but to
elevate standards of care. How can you raise standards of care when
one provider can get away from any standards and the other is held
accountable to the nth degree?”

Mary Ellen Conway, president of Capital
Healthcare Group, Bethesda, Md., not only questioned the wisdom
of exempting pharmacists but also the timing of the bill. “I think
it is a shame at this point to give [pharmacists] false hope,”
Conway said. “Even if this passes, it won’t be anytime soon.”

If pharmacists wait to see what happens, she noted, that could
put them in a risky position. “This is another potential
distraction that people look for, and it may not come to fruition,”
she said. “And then on Nov. 1 they are in trouble because all their
Oct. 1 claims have been denied [since they are not
accredited].”

Catizone agreed that pharmacies could be practicing risky
business if they wait on the outcome of H.R. 616.

“We know people are going to sit on the fence and say, ‘We’ll
wait and see what happens,’” he said, but “once they miss that
[Jan. 31] application deadline, accrediting agencies won’t be able
to get to them because they will have all those other
pharmacies.”

Even if pharmacies that wait to apply find an accreditor to take
them on, they — or any other providers who wait — could
run into trouble, Canally said. While her company does not, some
accreditors require providers to be ready for an inspection at the
time they submit their applications. And by Sept. 30, every
provider who wants to continue billing Medicare must ensure their
businesses are up to CMS standards, which can take time — and
that will be in short supply for those who wait, she continued. If
an accreditor finds any problems on the accreditation survey, for
example, that could mean further delay.

“God forbid they don’t make it through the first time and we
give them a corrective action plan and 60 days or so to complete
it,” Canally said. “If they wait until the final hour, they better
be bloody perfect because otherwise they are going to lose their
billing number.”

View a list of CMS’ 10 approved accreditation
organizations.