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Legislation & Regulation

Coverage of federal and state legislation and regulation affecting HME providers, home health agencies and patients.

  • From Congress to Health Care

    David Davis of Shared Health Services now focuses on wound care and hyperbaric therapy.
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  • Health Care Reform in Limbo

    Understanding the upcoming Supreme Court decision.
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  • Latest Legislation & Regulation News

  • John and Mark’s HME Issues Scorecard

    VGM’s John Gallagher and Mark Higley track the current barrage of legislative and regulatory challenges.
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  • Hobson, Ford Call for Repeal of Reimbursement Cuts

    Washington Reps. David Hobson, R-Ohio, and Harold Ford Jr., D-Tenn., have introduced a bill to rescind the Medicare reimbursement cuts scheduled for January 2005. Set out in the Medicare Modernization Act (MMA), the cuts align pricing of five DME categories — including oxygen and wheelchairs — with rates based on Federal Employee Health Benefits Plans (FEHBP) median pricing, and an Office of Inspector General (OIG) report on oxygen due out later this summer. After a lobbying day in June during the American Association for Homecare’s Legislative Conference, H.R. 4491 picked up nine co-sponsors, including Rep. Roy Blunt, R-Mont., the Majority Whip; Rep. Sherwood Boehlert, R-N.Y.; Rep. Jeb Bradley, R-N.H.; Rep. Jim Cooper, D-Tenn.; Rep. Virgil Goode, R-Va.; Rep. Steven LaTourette, R-Ohio; Rep. Jim Nussle, R-Iowa;…
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  • Respiratory Providers Gain Allies on the Hill

    Washington Industry lobbying may be paying off as legislators take note of MMA’s shortcomings — including its mandate of an ASP (average sales price) plus-6-percent reimbursement for inhalation drugs scheduled for 2005. The system could severely affect providers’ margins and, according to observers, could drive some HMEs out of business altogether. As a result, AAHomecare reported in June that Sen. Arlen Specter, R-Pa., sent a letter to CMS Administrator Mark McClellan explaining how the measure would hurt beneficiary access. Specter chairs the Senate Appropriations Subcommittee on Labor, Health and Human Services. “This pricing does not take into account the significant administrative costs associated with delivery of these home care therapies,” the senator wrote. “I therefore urge you, as you develop rulemaking, to use your discretionary…
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  • COPD Caucus Needs Our Support

    In a recent New York Times article, health writer Jane Brody wrote, “Perhaps the most frightening symptom one can experience is being unable to inhale enough air to perform even the simplest activities, like walking from the bedroom to the bathroom or even talking. But that is the ultimate fate of millions of Americans with chronic obstructive pulmonary disease.” Added to the personal suffering are enormous health care and financial consequences of COPD, which are summarized in an American Association for Homecare white paper on the disease. The direct medical costs in the United States total $18 billion annually. Thankfully, Sen. Michael Crapo (R-Idaho) has launched the Congressional COPD Caucus to advocate policies that encourage prevention and detection of the disease. Co-chairs of the caucus…
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  • Training Your Staff for Compliance

    Compliance training does not require the same education for all personnel. Handing employees the anti-kickback or HIPAA regulations accompanied by a big memo warning them to read and heed or face reprimand is neither necessary nor desirable. Lazy managers who lead by memo might take this route, but leaders building an effective company will take the time to train — and retrain — staff about the internal policies and procedures that matter to their individual job responsibilities. Obviously, your compliance team should possess dog-eared, tape-flagged, highlighted copies of useful HIPAA, reimbursement and anti-fraud resource materials and should keep trusted consultant phone numbers handy. However, the receptionist answering the phone, the delivery scheduler or the records manager need only be familiar with a few policies that…
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  • A Big Difference

    I can’t help it. Every time I visit Washington, my patriotic pride just seems to spill over. It was no different last month when I attended the American Association for Homecare’s Legislative Conference. On AAHomecare’s lobbying day June 8, I walked from one side of the Capitol to the other (and it’s a long way around) with Tim Pederson of WestMed Rehab, on the way to keep an appointment with Sen. Tom Daschle. Tim was part of a 200-strong cadre of association members crisscrossing the Hill to speak out against the DME reimbursement cuts scheduled next year. As we stopped for a breather, I snapped this photo of Tim on the Capitol steps — and had my newest patriotic moment as we discussed how much…
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  • Editor’s Inbox

    Accreditation Calculation Could you tell me what kind and by what entity Medicare will require accreditation of DME companies? By what date? — Michael Hardison, president, All-Med Home Care Inc., Poteau, Okla. Neither has yet been determined. In the meantime, HomeCare has published two recent articles on the subject that explain the how’s and what’s of getting started in the accreditation process, along with contact information for several of the accrediting bodies now working in the HME area. Look for “Mandatory Accreditation” by Jerold S. Cohen (February 2004) and “Getting Accredited and Doing It Now” by Tom Cesar (March 2004). You can access our magazine archives online at www.homecaremag.com. Not Again, Please I read with interest the story on the Power-Ox solution for qualification of…
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  • AAHomecare Members Fight MMA’s Reimbursement Changes

    As Washington rushed to prepare for former president Ronald Reagan’s funeral, 200 industry stakeholders fanned out over Capitol Hill to drive the home care message. During the American Association for Homecare’s Legislative Conference, held June 7-9, HME providers and manufacturers skirted hastily erected security fencing and crowd-control rails to keep appointments with 165 members of Congress and their legislative aides. Chief topics of discussion with the federal representatives were the DME reimbursement cuts and revised pricing for inhalation drugs mandated under the Medicare Modernization Act (MMA). In meetings with the legislative aides for Georgia Sens. Zell Miller and Saxby Chambliss, Dave Hunter of Air Products Healthcare laid out a case against the 2005 transition to an ASP (average sales price) plus-6-percent pricing system for Part…
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  • A Hard Look Ahead

    Respiratory care providers and manufacturers are no strangers to the government’s curve balls. Providers who participate in the Medicare program have made numerous changes to their business practices over the past two decades and, even with effects of such disastrous legislation as the Balanced Budget Act of 1997, have managed to remain solvent while keeping a focus on patient care and superior service. However, some industry leaders say provisions in the new Medicare Modernization Act (MMA) could have the greatest impact thus far. Aside from provisions mandating competitive bidding and provider accreditation, additional components of the MMA hit the home respiratory care market head-on. These include a freeze on price increases; a reduction in payment for respiratory medication; a change in the payment model for…
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  • Supplier Number Scheme Hits Florida

    Miami A new kind of DME fraud scheme has hit the Sunshine State that may turn innocent providers into unwitting participants. The Florida Association of Medical Equipment Services (FAMES) sent out a statewide alert to members last month warning providers of individuals who offer large cash sums to buy small HME businesses — and their provider numbers. In the contract, the buyers require providers to keep their supplier numbers open for a period of time after the transaction, during which — unknown to the seller — the buyers fraudulently bill Medicare with the “bought” supplier number. Once they bill a certain amount, they close the business. “This is a very fast scam. The buyers continue to bill under the seller’s provider number, [then get out]….
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