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the Deficit Reduction Act--and subsequent changes under the Medicare Improvements for Patients and Providers Act, which repealed the DRA's oxygen equipment transfer to beneficiaries but left the cap intact.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.