Long List of Provisions Affecting HME

WASHINGTON — Courtesy VGM Group, Waterloo, Iowa, an
analysis of the Senate’s health care reform bill — the
Patient Protection and Affordable Care Act (S.
3590) — identified the following issues as pertinent to HME
providers:

Sec. 3136 – Revision of payment for power-driven
wheelchairs.

Eliminates the option for Medicare to purchase power-driven
wheelchairs with a lump-sum payment at the time the chair is
supplied. Medicare would continue to make the same payments for
power-driven chairs over a 13-month period. Purchase option for
complex rehabilitative power wheelchairs would be maintained.

Sec. 9009 – Imposition of annual fee on medical device
manufacturers and importers.

Imposes an annual flat fee of $2 billion on the medical device
manufacturing sector beginning in 2010. This non-deductible fee
would be allocated across the industry according to market share
and would not apply to companies with sales of medical devices in
the U.S. of $5 million or less.

The fee does not apply to any sale of a Class I product or any
sale of a Class II product that is primarily sold to consumers at
retail for not more than $100 per unit (under the FDA product
classification system).

Sec. 6410 – Adjustments to the Medicare durable medical
equipment, prosthetics, orthotics, and supplies competitive
acquisition program.

Requires the Secretary to expand the number of areas to be
included in round two of the competitive bidding program from
79 of the largest metropolitan statistical areas (MSAs) to 100 of
the largest MSAs, and to use competitively bid prices in all areas
by 2016.

Sec. 6411 – Expansion of the Recovery Audit Contractor (RAC)
program.

Requires States to establish contracts with one or more Recovery
Audit Contractors (RACs). These State RAC contracts would be
established to identify underpayments and overpayments and to
recoup overpayments made for services provided under State Medicaid
plans as well as State plan waivers. The Secretary would also be
required to expand the RAC program to Medicare Parts C and D.

Sec. 6405 – Physicians who order items or services required to
be Medicare enrolled physicians or eligible professionals.

Requires durable medical equipment (DME) or home health services
to be ordered by a Medicare eligible professional or physician
enrolled in the Medicare program. The Secretary would have the
authority to extend these requirements to other Medicare items and
services to reduce fraud, waste, and abuse.

Sec. 6407 – Face-to-face encounter with patient required before
physicians may certify eligibility for home health services or
durable medical equipment under Medicare.

Requires physicians to have a face-to-face encounter with the
individual prior to issuing a certification for home health
services or DME. The Secretary would be authorized to apply the
face-to-face encounter requirement to other items and services
based upon a finding that doing so would reduce the risk of fraud,
waste, and abuse.

Sec. 6401 – Provider screening and other enrollment
requirements under Medicare, Medicaid, and CHIP.

Provider Screening. Requires that the
Secretary, in consultation with the HHS Office of Inspector General
(HHS OIG), establish procedures for screening providers and
suppliers participating in Medicare, Medicaid, and CHIP. The
Secretary would be required to determine the level of screening
according to the risk of fraud, waste, and abuse with respect to
each category of provider or supplier. At a minimum, all providers
and suppliers would be subject to licensure checks. The Secretary
would have the authority to impose additional screening measures
based on risk, including fingerprinting, criminal background
checks, multi-State data base inquiries, and random or unannounced
site visits. An application fee of $200 for individual
practitioners and $500 for institutional providers and suppliers
would be imposed to cover the costs of screening each time they
re-verify their enrollment (every five years).

Disclosure Requirements. Providers and
suppliers enrolling or re-enrolling in Medicare, Medicaid, or CHIP
would be subject to new disclosure requirements. Applicants would
be required to disclose current or previous affiliations with any
provider or supplier that has uncollected debt, has had their
payments suspended, has been excluded from participating in a
Federal health care program, or has had their billing privileges
revoked. The Secretary would be authorized to deny enrollment in
these programs if these affiliations pose an undue risk to a
program.

Compliance Programs. By a date determined by
the Secretary, certain providers and suppliers would be required to
establish a compliance program. The requirements for the compliance
program would be developed by the Secretary and the HHS OIG.

Sec. 6402. Enhanced Medicare and Medicaid program integrity
provisions.

Surety Bonds. Requires that the Secretary take
into account the volume of billing for a DME supplier or home
health agency when determining the size of the surety bond. The Secretary would have
the authority to impose this requirement on other providers and
suppliers considered to be at risk by the Secretary.