House Health Reform Bill Includes Changes for DME

WASHINGTON—Earlier today, the House
Tri-Committee—made up of the Ways and Means, Energy and
Commerce, and Education and Labor Committees—released an
updated draft of its massive health care reform bill.
 
While the bill—the American’s Affordable Health Choices
Act (H.R. 3200)—does not include additional cuts to oxygen,
it does require providers in month 27 of the 36-month cap period to
continue providing oxygen during the period of medical need through
the end of the equipment’s useful lifetime, regardless of the
patient’s location, unless another supplier accepts
responsibility. 
 
As expected, the House bill also includes elimination of the
first-month purchase option for standard power wheelchairs,
although it maintains the option for Group 3 PWCs.
 
In addition, the updated draft exempts some pharmacies from
CMS’ DMEPOS surety bond and accreditation requirements and
increases the funding to fight fraud and abuse.
 
According to a Legislative Update from Waterloo, Iowa-based VGM
Group, the following is a summary of what analysts have cited so
far in the 1,018-page draft:

· Oxygen
– No additional cuts to oxygen payments have been
included. However, providers furnishing oxygen equipment at month
27 must continue to furnish the equipment, regardless of the
patient’s location, during any subsequent period of medical
need for the remainder of the reasonable useful lifetime of the
equipment (60 months. Providers may furnish the equipment either
directly or by making arrangements with other providers. In the
case of a provider who has declared bankruptcy and has liquidated
its assets, a new 36-month rental period with a new oxygen provider
may begin if more than 24 months of rental payments have been made
on the patient’s current rental period.

· Power
Wheelchairs – The first-month purchase option for power
wheelchairs will be eliminated for those in Groups 1 and 2, but
complex rehab chairs in Group 3 or higher will not be
affected. 

· Surety
Bonds – A pharmacy that has been enrolled as a DME
provider, has had a provider number for at least five years and has
never had an adverse action does not need to obtain a surety
bond. 

· Accreditation
– A pharmacy enrolled as a DME provider, providing only
diabetic testing supplies, canes and crutches does not need to
apply for accreditation. Any provider that has submitted an
application for accreditation before Aug. 1, 2009, will be deemed
as meeting applicable standards and accreditation requirements
unless the independent accreditation organization takes action on
the provider’s application.

· Fraud and
Abuse – The bill includes increased funding to fight
fraud and abuse as well as enhanced penalties for fraudulent
activities.  

To view the entire bill, click here.

According to the American Association for Homecare, this version
of the draft legislation is likely to be “marked up”
(debated and/or amended) by the House committees later this
week.

Both VGM and AAHomecare said they continue to review the
proposed legislation and will provide further analysis. Both
organizations are also urging providers to contact their federal
legislators about provisions in the measure as Congress continues
the debate on health care reform.
 
To contact your members of Congress, dial the U.S. Capitol
switchboard at 202/224-3121. The operator will connect you directly
to your legislator’s office.