Challenges and Victories from AAHomecare Update

ATLANTA (October 22, 2019)—AAHomecare’s Washington Update on Day Two of Medtrade started with a moving tribute, a robust account of AAHomecare’s activities, and four women vying for VGM’s Woman of the Year Award.

AAHomecare president and CEO Tom Ryan started the session by announcing that beloved and respected New England advocate Karyn Estrella would receive the 2019 Van G. Miller Homecare Champion Award. Estrella passed away on July 4, 2019, and was well known for her work as executive director of the Home Medical Equipment and Services Association of New England (HOMES).

Karyn’s daughter Lauryn Estrella accepted the award with her sister, Jaimie Pogany. Lauryn is currently serving as interim executive director of HOMES. “Karyn inspired others and mentored others,” said an emotional Tom Ryan. “She cared.”

“When God created Karyn, he dipped her in the passion bucket just a bit longer—because she was so cute,” added Jim Greatorex, a long-time HME owner in Maine and current vice president, VGM Live at Home. “The only person who has hugged me more is my wife.”

Victories and Challenges
AAHomecare officials called for unity and additional growth to help the association continue the fight. Jay Witter, senior vice president, Public Policy, outlined several 2019 accomplishments, such as:

• CMS adopted most of AAHomecare product category recommendations for Round 2021 (commodes, walkers, beds, support surfaces, sleep, oxygen, manual and power wheelchairs).

Favorable changes to the targeted probe and education (TPE) process:

• CMS clarified that MACs shall implement edits for Round 2 and Round 3 based on the date of service and not the date the claim was submitted.
• CMS clarified that MACs shall allow 45 to 56 days between each education intervention and the next round for the provider/supplier to improve.
• CMS implemented the TPE 10-Claim Preview Pilot for DME; suppliers that show compliance on all 10 claims will be released from the TPE process for that HCPCS code for approximately one year.
• CMS recommended MACs combine sleep accessories into one TPE audit.

On the pesky topic of competitive bidding, Ryan commented: “We finally convinced them [CMS] it was broken. We got the program put on hold. Just by getting the clearing house bids in and the surety bonds it will improve.”

Non-bid area relief and O2 reimbursement is still on the legislative agenda with HR 2771 via the “Protecting Home Access Act of 2019” currently with 46 co-sponsors. The bill would make permanent the rural relief for non-rural, non-competitive bidding areas at a 75/25 blended rate (CB rates/unadjusted fee schedule rates). It would also eliminate the O2 budget neutrality requirement.

HME Woman of the Year
Finalists for the 2019 HME Woman of the Year were: Donna Cady, managing director, Mercy Health St. Rita’s Medical Center; Deb Kalk, CEO and president, Reliable Medical Supply; Leigh Ann Mathews, ATP, CRTS, Complete Care Stores; and Wendy Russalesi, chief compliance officer, AdaptHealth

Now in its fourth year, the award, sponsored by VGM, recognizes one woman in the industry who has made significant contributions throughout her career to her company, community, and the HME industry. Wendy Russalesi ultimately took home the top prize.

By Greg Thompson