By all accounts, the effects of CMS' proposed revision and expansion of supplier standards for DMEPOS will be far-reaching. In a special series for HomeCare Monday leading up to the March 25 deadline for comments, health care attorney Neil B. Caesar, president of the Health Law Center, Greenville, S.C., will help provide clarification and insight on several provisions of the draft rule. This week, Caesar's comments are directed to proposed Standard No. 29, which deals with supplier practice locations.
New Standard 29 specifies that a supplier would be "prohibited from sharing a practice location with another Medicare supplier." This is actually a strangely worded supplier standard. National Supplier Clearinghouse policy already prohibits two DMEPOS suppliers from commingling their space or operations, so it is possible that CMS is simply trying to formalize ... what has been implicit in the standards as part of the NSC's ongoing enforcement policy.
On the other hand, much of the commentary to the standard suggests a broader application. For example, in discussing the scope of the new rule, CMS notes that a supplier is not allowed to share a practice location with others "including a physician/physician group."
Further, CMS elaborates: "Since we are aware that physicians and other licensed non-physician practitioners may obtain their own DMEPOS supplier number and furnish DMEPOS from their office, we are soliciting comments on whether we should establish an exception to this space-sharing proposal for physicians and non-physician practitioners and the circumstances which warrant an exception."
This language suggests that CMS intends the new standard to do no more than capture the existing NSC policy; mainly, that two suppliers may not commingle their practice locations, operations, staff, inventory and other aspects of supplier operations.
I have often worked with suppliers to negotiate with the NSC an operational sharing of certain resources between suppliers, often suppliers with related ownership. Closed-door pharmacies, for example, sometimes share personnel or real estate. If the operations and records are sufficiently segregated to enable the NSC to evaluate compliance by each supplier with all of the standards, then that should satisfy CMS' concerns.
In the past, subcontracts have been negotiated successfully to allow the efficient utilization of specialized personnel, such as knowledgeable billing staffers. When a subcontract for use of such personnel has been drafted to segregate the time spent on behalf of each supplier--so that work is not being done for both suppliers at the same time--that has typically been sufficient to placate the NSC. It remains to be seen whether such efficiencies will be permitted under the new standard.
To view the proposed supplier standards rule, click here.
Comments are due by March 25. Electronic comments can be
submitted at
http://www.regulations.gov. Follow the instructions under the
"Comment or Submission" tab and enter the file code
CMS-6036-P.