Oxygen Reform Hits Another Bump on Rocky Road

WASHINGTON — After months of contentious
provider-vs.-provider wrangling on the components of a Medicare
oxygen reform plan, on Wednesday, Rep. Mike Ross, D-Ark., presented
his oxygen proposal to the House Energy and Commerce Committee as
an amendment to H.R. 3200, the House health care reform bill. But
now there’s another hitch.

The Congressional Budget Office says the plan could cost the
program money even though it was designed to be budget-neutral
— meaning it wouldn’t add any cost — according to the
American
Association for Homecare‘s Mike Reinemer, vice president,
communications and policy.

Ross did receive assurance from committee Chairman Henry Waxman,
D-Calif., however, that the two of them would work through the
questions about the amendment’s cost, Reinemer said. If those
issues can be resolved, the next stop for the plan will be the
House Rules Committee, where it will be considered for inclusion in
the larger health reform package that would go to the House
floor.

Here’s AAHomecare’s rundown of the plan’s highlights:

• It would repeal the 36-month cap on oxygen payments.
• It would maintain “supplier” status for HME providers who
  furnish home oxygen therapy.
• It would implement a cost survey to be completed by a
  statistically representative sample of suppliers each year rather
  than by all oxygen suppliers.

A geographic adjustment provision was eliminated from the plan
after an Aug. 18 stakeholder meeting to work out the industry’s
differences on the proposal. In addition, the issue of competitive
bidding would be addressed in a stand-alone measure instead of
including it as a provision of oxygen reform.

But there is also another sticking point within the industry.
The Ross plan includes an interim payment system for the period
between repeal of the 36-month oxygen cap and implementation of a
new rate structure that would set the combined portable Medicare
payment rate at 90 percent of the current allowable.

New technology would remain at the current level. Once the 90
percent calculation is made for combined portable,
concentrator-only rates would be determined in accordance with the
mandate that the payment system be budget-neutral.

According to a Sept. 22 update from the National Association of
Independent Medical Equipment Suppliers — which along
with CSI:HME and
some state associations opposes the 90 percent interim rate —
the association said it has endorsed a revised version of the Ross
proposal “that accomplished all of the above goals as well as
protected the payments for combined stationary and portable
patients at 100 percent of the current combined fee … We have
sent this proposal to Mr. Ross with endorsements from numerous
organizations.”

Meanwhile, as of press time, no oxygen provisions had been added
to the Senate Finance Committee’s health reform legislation,
although observers said that could still happen.

“Were the Senate to address the 36-month cap, it would probably
involve a cut to the overall benefit of $1 billion over 10 years,”
AAHomecare reported last week.