Medical Supplies Council in action

WASHINGTON, Sept. 19, 2012—The AAHomecare Medical Supplies Council has tackled several critical issues in recent months. Members of the Council and AAHomecare commented on the proposed application of inherent reasonableness (the ability for CMS to adjust reimbursement rates) for diabetic testing supplies furnished in a retail setting. AAHomecare’s comments focused on the irrationality of applying IR to testing supplies because the reduction is based on rates resulting from the flawed CMS competitive bidding scheme. CMS has yet to release their final formula and rationale for applying IR to diabetic testing supplies. The Medical Supplies Council will continue to monitor this issue and provide expert comments.

The council also formed two working groups—an ostomy work group and a fistula work group. The ostomy work group is addressing coverage issues for supplies above the maximum allowed by the coverage policy. The coverage policy issued by CMS allows for additional supplies if they are medically necessary. However, as implemented, many claims for additional supplies are denied by the DME MACs, and then subsequently approved on appeal. Although they are ultimately paid upon appeal, DME MAC reviewers have made providing medically necessary supplies extremely difficult.

The fistula work group is developing a comprehensive policy to cover fistulas. There are two policies under which it would be reasonable to expect coverage for fistula pouches, the surgical policy and the ostomy supplies policy. The work group is developing a proposal to present to CMS that would cover fistulas created by means other than surgery, including Crohn’s disease. The group hopes to develop a policy that will cover the appropriate equipment to treat fistula, a goal which will ultimately save Medicare dollars.

Finally, the Medical Supplies Council is monitoring implementation of Accountable Care Organizations, changes to HME reimbursement in state Medicaid programs, and edits to local and national coverage determinations.

If you are interested in joining the council contact Pete Rankin at [email protected] or 202-372-0755. The council holds two face-to-face meetings annually and has conference calls on the third Thursday of each month. Go to www.aahomecare.org.