Price Asks House Colleagues to Act on Oxygen Payments

WASHINGTON — In a Feb. 9 letter addressed to House leaders
and members of key committees, Rep. Tom Price, R-Ga., asked his
colleagues for help in urging CMS to set adequate payments for
oxygen after the 36-month cap period. He also asked them to
consider further congressional action on the matter should it be
necessary.

“Without immediate changes to the Medicare oxygen policies,
patient care will be compromised and Medicare costs will increase,”
the letter read.

Price, a physician, has twice introduced legislation to repeal
the oxygen cap (see Price
Reintroduces Bill to Repeal O2 Cap, HomeCare Monday,
Jan. 29, 2007). Yesterday’s letter, also signed by Reps. Mike Ross,
D- Ark.; Jo Ann Emerson, R-Mo.; and Health Shuler, D-N.C., pointed
out that home oxygen “is a critical, life-sustaining medical
treatment” and said both patients and providers have begun seeing
the detrimental effects of the new oxygen rules.

HME advocates in town for AAHomecare’s lobby day Feb. 11 planned
to hand-carry the letter to Capitol Hill congressional offices in
hopes of garnering additional support.

The text of the letter follows in full:

February 9, 2009

We are writing today to ask that the Ways and Means
Committee and the Energy and Commerce Committee urge the Centers
for Medicare and Medicaid Services (CMS) to provide appropriate
payments for home oxygen therapy to continue through the
beneficiary’s period of medical need. Specifically, we are
concerned that current CMS post-36 month payment policies, which
went into effect on January 1, 2009, are adversely impacting
quality home oxygen therapy.

As you are aware, prior to the Deficit Reduction Act of 2005
(DRA), home oxygen therapy was paid through a bundled rental and
service payment that covered the cost of equipment, service,
repairs and supplies as long as the therapy was medically
necessary. A provision in the DRA limited monthly rental payments
to oxygen providers to 36 months of continuous use. After 36
months, Congress instructed CMS to establish adequate payments for
continued care of these patients. Unfortunately, despite the
authority Congress provided CMS, the agency has not established
adequate payments after the 36th month.

CMS’ final rule, published on October 30, 2008, addressing
the treatment of oxygen therapy post 36 months, established very
limited payment levels and unreasonable obligations that are
impeding the provision of quality care to Medicare beneficiaries on
home oxygen therapy. These policies require the original home
oxygen provider to continue to provide, without any payment,
unscheduled service and maintenance visits, 24-hour emergency care,
equipment repairs, and oxygen supplies and accessories for a two
year period following the rental cap. The rule also establishes
inadequate payment levels for scheduled maintenance and service
equal to one visit every six months at a payment rate of
approximately $30 per visit.

Patients and providers have begun seeing the detrimental
effects of the recently implemented Medicare oxygen rule. We are
aware of several different scenarios that are occurring with
patients who have reached or are nearing the 36-month rental
cap:

1. A patient who would like to move out of the original
   provider’s service area, but the provider cannot find a company in
   the new area that is willing to provide home oxygen therapy in the
   new location, due to the minimal payment levels.
2. A hospital that is seeking to discharge a patient to a
   different area of the country but is unable to find an oxygen
   provider and therefore cannot discharge the patient, forcing the
   Medicare program to pay for additional beneficiary time in the
   hospital.
3. A patient who would like to switch providers cannot find
   another company willing to provide home oxygen therapy, due to
   minimal payment levels.
4. A company is going out of business and patients cannot find a
   new home oxygen provider, again, due to minimal payment
   levels.

Home oxygen is a critical, life-sustaining medical treatment
prescribed to nearly 1.5 million Medicare beneficiaries annually
who suffer from respiratory illnesses such as chronic obstructive
pulmonary disease (COPD). COPD is a progressive, incurable disease
that causes irreversible loss of lung function. Although
medications have not been shown to be beneficial in reversing lung
damage, home oxygen therapy, when properly prescribed and
maintained, has been shown to slow the progress of this
degenerative disease.

Home oxygen providers are more than just suppliers of
equipment, they are also front-line caregivers. They educate
patients on the proper use their equipment, answer patients’
questions, make repairs and adjustments, and ensure that patients
are receiving the prescribed amount of oxygen. These providers are
on the first line of care for Medicare beneficiaries who require
home oxygen therapy. They take calls at all hours and in rural
areas drive long distances to make sure that their patients receive
the care they need. Without reimbursements for these visits,
suppliers will not be able to afford to provide the current level
of care for many of these oxygen patients.

We seek your assistance in urging CMS to revise post-36
month oxygen payment policies to address serious shortcomings that
are creating hardships for both oxygen patients and providers of
these services. Without immediate changes to the Medicare oxygen
policies, patient care will be compromised and Medicare costs will
increase.

We look forward to working with you on this critical issue
and hope you will consider taking further congressional action
should it be necessary. We appreciate your attention to this matter
as we work to protect beneficiary access to the home oxygen therapy
and strive for reform of the benefit.

Sincerely,
Tom Price, MD
Member of Congress

Mike Ross
Member of Congress

Jo Ann Emerson
Member of Congress

Heath Shuler
Member of Congress