March 1 Is ‘Line in the Sand’ for Some Pharmacies

WASHINGTON — While today’s accreditation deadline applies
to all pharmacists billing Medicare for DMEPOS, it should be
business as usual for many, according to the NCPA.

“Our surveys show that 70 percent of independent community
pharmacists have already obtained accreditation,” said William
Popomaronis, vice president of long-term care and home health care
pharmacy services for the National Community Pharmacists
Association, which represents 23,000 pharmacies.

“Of the 30 percent left, some are stepping down [from Medicare],
but you have a few — about 1,000 or 1,500 — that have
done nothing,” he continued. “They have sent in a surety bond, but
they have done nothing else. The line in the sand has been drawn
for them.”

Congress gave pharmacies an accreditation extension last fall,
pushing the deadline from Oct. 1 to Jan. 1. In a late December
memo, CMS had said revocations for those not meeting the
requirement would be prioritized “based on any potential
beneficiary access issues as well as the agency’s workload.” The
agency recently announced March 1 as the cutoff date.

According to a spokesman for CMS, “97 percent of pharmacies meet
the accreditation requirements and many other pharmacies are in
various stages of the accreditation process.”

Pharmacists that are not accredited cannot bill Medicare for
DMEPOS; however, with a surety bond, they can continue to provide
chemotherapy and inhalation drugs to Medicare beneficiaries.

Many of those who have neither accreditation nor a surety bond
and who are banking on ultimately being exempted from the
requirements have voluntarily terminated their Medicare enrollment,
Popomaronis said, rather than having their billing numbers
revoked.

“If they are revoked, then they can’t reapply for a year. If
they step down, it’s like turning the switch back on [if an
exemption comes through],” Popomaronis said.

Pharmacists have objected to both the requirements, calling the
accreditation rule redundant, unnecessary and unfair and the surety
bond too burdensome cost-wise. Some have argued that the amount of
Medicare business they do doesn’t justify the expense for
accreditation or the bond.

“We’re licensed, we’re regulated, we have product and liability
insurance,” Popomaronis said, adding that Boards of Pharmacy also
oversee the sector. The NCPA and other pharmacy organizations
believe pharmacists are entitled to the exemption CMS has already
granted to other health care professionals such as physicians,
prosthetists and occupational and physical therapists.

The pharmacy groups have taken their case to Capitol Hill, and
some
legislators agree. An exemption was included in Sen. Harry
Reid’s (D-Nev.) original jobs bill, and it is included in President
Obama’s proposed health care plan, Popomaronis said.

However, Reid, the Senate majority leader, has since introduced
a vastly scaled-down jobs bill, and the provision is not in it,
according to Mark Higley, vice president of development for
Waterloo, Iowa-based VGM Group.

But that doesn’t trouble Popomaronis.

“Congress is looking at exemptions for pharmacists,” he said,
noting he believes the provision could be added back into the
legislation.

In addition, Popomaronis pointed out, there is H.R. 616, a
separate bill that would exempt pharmacists from the accreditation
requirement. As of Feb. 26, the bill had 97 cosponsors, and a
companion bill in the Senate (S. 511) had 15.

“While [all of] this is stalled, we believe that somehow
compromise is going to come,” Popomaronis said.