Montana Beneficiaries Could Lose Access, CMS Says

DENVER — In an Oct. 30 email, a CMS representative said
Medicare beneficiaries in some areas of Montana “may experience
supplier access issues in obtaining certain DMEPOS.”

A CMS staff member from the agency’s Division for Medicare
Health Plans Operations, Region VIII, noted in the Friday afternoon
message that “potential access issues” with oxygen, enteral
nutrition, parenteral nutrition and power wheelchairs could affect
beneficiaries’ access for the following equipment and supplies in
eight Montana counties:

• Oxygen — Daniels, Sheridan, Roosevelt, Phillips,
  Musselshell and Fegrus
• Enteral Nutrition — Stillwater and Carbon
• Parenteral Nutrition — Roosevelt, Stillwater and
  Carbon
• Power Wheelchairs — Sheridan, Stillwater and Carbon

“Keep in mind this information is subject to change because
supplier accreditation is ongoing,” read the email, suggesting that
the access issues are related to the agency’s recently implemented
surety bond and accreditation requirements.

In addition, the email said, “If a beneficiary’s supplier
doesn’t meet these new requirements, the beneficiary will have to
look for another Medicare-approved supplier in order for Medicare
to pay for their equipment and supplies. If a beneficiary continues
to get supplies from a supplier who has not met these requirements,
Medicare won’t pay and the beneficiary may have to pay the full
cost for the supplies … Although most suppliers will continue
in the Medicare program, some have chosen not to stay
enrolled.”

The message advised that “beneficiaries should ask if their
current supplier plans to meet these new Medicare program
requirements to avoid any interruption in their services.”

While the email was sent to an unspecified list including some
home medical equipment providers, CMS has apparently been sending
beneficiaries across the country the same message.

According to Rose Schafhauser, executive director of the Midwest
Association for Medical Equipment Services, customers of some MAMES
members have been receiving letters telling them that if their
medical equipment supplier “hasn’t yet met the new requirements to
become Medicare-approved, starting October 1, 2009, the supplier
can no longer bill Medicare for your medical equipment or
supplies.”

Signed by CMS Acting Administrator Charlene Frizzera, the letter
reads:

 ”These new Medicare program requirements for suppliers
were created under the law and are intended to protect you and
Medicare from fraud. They also ensure that by using a
Medicare-approved supplier, you can have peace of mind that you are
getting high-quality products and services. As always, you may
continue to use your current supplier. However, if they don’t meet
the new requirements, you may need to pay the full cost for your
supplies.”

“CMS did not list the company name on the letter,” Schafhauser
noted in MAMES’ Monday newsletter, “but this didn’t seem to matter
for customers [who] have been calling the home medical equipment
companies extremely upset. In addition, we are hearing reports
throughout the country that beneficiaries are receiving these
letters — so it seems that CMS has released these letters
across the country.” 

“My real problem with all of this is from the patient
perspective,” said Wayne Stanfield, president of the National
Association of Medical Equipment Suppliers. “CMS is putting the
burden on the frailest, sickest people in the Medicare system who
rely on home care to ensure their quality of life. Now all of a
sudden they are put in the position of having to police the care
they are getting, and Medicare is telling them Medicare won’t pay
their bills. That’s got to be causing significant stress for a lot
of patients.”

Because the CMS email on potential Montana problems “came from
the Part A side,” Stanfield said, “my guess is that the issues
related to access came to light because physicians or hospitals
were unable to find providers in those counties that were able or
willing to serve patients.

“If this is happening in Montana, this is happening in 15 or 20
other predominantly rural states right now,” Stanfield said. “The
truth is it’s also going to hit any states that have large spaces
between towns.”

Instead of helping Medicare beneficiaries continue to get
high-quality products and services and prevent fraud, he said, the
accreditation and surety bond requirements could cause interruption
in patient care.

“It’s clear the $50,000 surety bond mandate per store combined
with up to $25,000 accreditation cost is a financial burden too
great for many small independent suppliers to shoulder,” Stanfield
said.

“The email talks about how the two programs that have created
these access issues were designed to eliminate fraud and abuse
while still assuring quality products are provided, but no matter
how you look at it, these programs are eliminating suppliers, and
they are eliminating small, independent suppliers who … may
be the only supplier in small-town, rural America.”

Competitive bidding
will only worsen the situation, he continued.

“Everything is impacting the patient,” Stanfield said. “The
unfortunate thing is that in [CMS’] zeal to curb fraud and abuse
and to limit suppliers, they are harming the people who need the
services.”