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 an expansion of existing standard No. 7 dealing with physical facilities and signage, and to standard No. 9 regarding the business telephone.
Standard No. 7 currently requires that a provider maintain a physical facility at an appropriate location and that the facility contain space for storing various types of business records. CMS proposes several revisions to this standard. First, the agency wants to require that suppliers maintain business records for seven years after the claim has been paid. This requirement is not necessarily burdensome, but it does suggest that suppliers need a formal, well-organized system for records storage and access.
The second revision requires the supplier location to be accessible to beneficiaries and CMS during posted business hours. Further, there must be a sign identifying the company that is permanent and durable, and that is visible at the main entrance to the public including customers using wheelchairs. CMS states that a supplier whose business is located within a building complex must have its sign visible at the main entrance. This latter requirement could be a problem for providers in multiple-tenant buildings because landlords often have strict signage rules that may conflict with CMS' proposed revision.
CMS also clarifies that the business must be staffed during the posted hours of operation, regardless of whether visitors are coming. This is not problematic on its own. But in combination with [a new standard CMS has proposed that] requires suppliers to be open a minimum of 30 business hours weekly, this standard may severely limit the ability of one- or two-person HME companies to staff the office and handle deliveries within a normal business week.
CMS also clarifies that these proposed revisions apply to "closed door" companies "such as pharmacies, or suppliers providing services only to beneficiaries residing in a nursing home."
Under this standard revision, CMS is also seeking comments about whether to impose a minimum square footage requirement. Again, such a requirement raises questions of fairness for small suppliers and closed-door companies.
CMS emphasized in its comments a supplier that is not open during posted hours when NSC inspectors arrive will have its supplier number yanked. It is unclear whether CMS would take this strict approach after only one missed visit, but this newly emphasized strictness is reiterated in CMS' comments about standard No. 8, which deals with on-site inspections and accessibility.
CMS' proposed revision to standard No. 9 deals with the business telephone. It currently requires that a supplier maintain a business phone under the business' name for use by beneficiaries. The standard currently emphasizes that a supplier may not use alternate means of communication as the primary business telephone, such as beepers, answering services, pagers, fax machines, car phones or answering machines.
CMS now proposes to revise this standard to exclude cell phones and beepers altogether as a method of receiving calls, and further seeks to prohibit all "call forwarding" from beneficiaries or the public to a cell phone or beeper during posted hours of operation. Apparently, such call forwarding would be allowed outside of posted hours.
This new requirement tracks CMS' seeming insensitivity to small suppliers, which is reflected throughout these proposed revisions, because it makes it quite difficult for a supplier to make deliveries during business hours while still remaining accessible to the public.
Clearly, CMS' intent reflected in these standards is that every supplier should operate like a retail shop. Someone should always be sitting behind the counter answering the telephone and awaiting visitors. In one- or two-man operations, deliveries, etc., may have to wait until the close of business.
In light of the primary focus of Medicare HME providers on servicing customers who cannot easily and routinely visit their stores, this emphasis on the retail location may be excessive.
View the proposed supplier standards rule.
Comments on the proposed supplier standards are due March 25,
2008. Comments may be submitted online at www.regulations.gov. Follow the instructions
under the "Comment or Submission" tab and enter the file code
CMS-6036-P.