NAIMES Reiterates Need for Oxygen Cap Info

HALIFAX, Va.–In a statement issued Friday, the National
Association of Independent Medical Equipment Suppliers said it had
written to CMS Acting Administrator Kerry Weems–again–about rule
changes related to the 36-month oxygen rental cap. This time, the
organization said, its letter asked for an immediate response.

“The industry simply cannot wait any longer to get the needed
policy revisions, HCPCS codes and fees along with clarification of
supplier responsibility after the cap begins on Jan. 1,” said Wayne
Stanfield, NAIMES president. The association also wrote to key
members of the House and Senate.

NAIMES said it had received no response to an Aug. 21 letter
asking Weems to release the information by Oct. 1 to allow
“time for providers to make informed decisions about their
future. Suppliers must notify patients no later than Nov. 1, 2008,
of their intent and ability to serve them after the cap begins.
NAIMES counsel has advised us that failure to notify patients 60
days prior to the cap start date could result in the supplier being
obligated to serve those patients for the remaining 24 months,
regardless of the payment policy.”

The association noted some providers it had contacted said
between 25 and 40 percent of their patients would cap on Jan. 1,
with a much smaller percent capping each month after.

“Several providers indicated they have patients that have
been on oxygen therapy service for four to five years already,
particularly in large retirement areas,” the NAIMES statement
said.

Other industry organizations have also voiced concerns about
lack of information related to the oxygen cap–mandated by the
Deficit Reduction Act–and subsequent changes under the Medicare
Improvements for Patients and Providers Act, which repealed the
DRA’s oxygen equipment transfer to beneficiaries but left the cap
intact.

With many of its members based in Florida, the Accredited
Medical Equipment Providers of America is particularly worried
about patient travel issues under the cap when it comes to
“snowbirds.” In a recent newsletter, AMEPA
explained:

“According to the rule, Medicare will stop paying for
oxygen service after 36 continuous monthly payments. If a patient
began using oxygen on or prior to Jan. 1, 2006, Medicare will make
the final payment for the oxygen service on the 36th month:
December 2008. If a patient using oxygen since January 2006 intends
to change their oxygen provider in October, the new provider may
only be paid for oxygen service for the months of November and
December and then the equipment will ‘cap out.’

“If the seasonal patient decides to permanently change
their residence, the provider may only receive two months, or
approximately 5 percent, of the typical reimbursement, and the
patient might be able to keep the oxygen equipment for as long as
it is medically necessary.”

In a survey of its members who provide oxygen in Florida, AMEPA
said all of the non-participating providers said they would not
accept assignment for oxygen patients scheduled to cap this season.
“Additionally,” the organization said, “patients
returning north after the season may find it impossible to find a
Medicare provider willing to provide oxygen to the patient after
they completely cap out in December.”

In August, the American Association for Homecare submitted a
list of nearly two dozen questions related to the impending cap and
revisions under MIPPA, among them whether providers can set up
service contracts with beneficiaries after the rental payments cap.
(See HomeCare Monday, Aug. 25.)

According to NAIMES, this particular issue was discussed in a
recent Region C Council meeting, with mixed opinions on the issue.
“Carrier and CMS representatives seem to agree that suppliers
can charge for services under certain undefined circumstances, and
suggested suppliers contact their legal advisors. Unnamed sources
indicate that some companies are creating a cafeteria menu of
services to offer to patients which they consider outside the
services covered by a Medicare payment. Among these are charges for
monthly/quarterly visits, 24-call, additional tanks and back-up
equipment,” the association said.

“CMS has been aware of the cap since November 2005, and
yet we are about 75 days away and they are still dodging the
issue,” the NAIMES statement read. “Many believe that
CMS does not understand the gravity of the situation facing a
million-plus Medicare oxygen therapy patients and the providers
serving them.”

In an Open Door Forum Sept. 17, CMS’ Joel Kaiser, deputy
director of DMEPOS policy, told listeners the agency was “still in
the planning stages” for provisions surrounding the oxygen cap but
that additional information would be announced “soon.”

However, in a Sept. 29 “listening session” on the issues with
members of AAHomecare’s Regulatory Committee, CMS officials told
the group they would not provide a timeline for release of the
oxygen program instructions.

To read NAIMES’ letter to CMS’ Weems, visit
www.dmehelp.org

To view the complete list of questions AAHomecare submitted to CMS,
visit
www.aahomecare.org.