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Legislation & Regulation

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

  • NSC Extends Compliance Window

    Columbia, S.C. Following a mid-April advisory board meeting with DME industry representatives, the NSC said it will, in certain instances, give providers an additional 21 days to prove compliance before beginning supplier-number revocation actions. “All [21 supplier] standards are important. It is the responsibility of suppliers to be in compliance with each one of these standards at all times,” the NSC said in a statement. “However, there are circumstances where it may be appropriate to develop … more information before action is taken. All circumstances will be taken into consideration to determine whether or not additional development is warranted. The intent of this is to ensure the NSC has gathered all pertinent data and the supplier has had sufficient opportunity to provide evidence of compliance.”…
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  • Bush Calls for Electronic Medical Records for Every American

    Minneapolis During an April 26 speech promoting innovation, President Bush set a goal that in 10 years every American should have an electronic medical record. The goal follows a call for computerization of health care records in his Jan. 20 State of the Union address. In a speech at the American Association of Community Colleges’ annual convention in Minneapolis, the president also announced the creation of a sub-Cabinet-level position for a “national health information technology coordinator” who will report directly to the Secretary of Health and Human Services. The new coordinator will foster partnerships between the public and private sectors to speed information technology (IT) into the health care market. The announcement comes after the President’s Information Technology Advisory Committee (PITAC) released a draft report…
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  • Latest Legislation & Regulation News

  • Crapo Chairs COPD Caucus

    Washington Sen. Michael Crapo, R-Idaho, has announced formation of the Congressional COPD Caucus, which will educate Americans about chronic obstructive pulmonary disease and promote policies to improve the lives of COPD patients. Crapo, who will chair the caucus, will be joined by Sen. Blanch Lincoln, D-Ark., and Reps. John Lewis, D-Ga., and Cliff Stearns, R-Fla. The Centers for Disease Control and Prevention estimates that 24 million Americans suffer from COPD, but only about 10 percent have been diagnosed with the lung disease. For breaking news, go to www.homecaremonday.com, the electronic news service of the home medical equipment industry.
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  • The Road to Progress

    My phone has not stopped ringing these past few months. Friends have been asking me the same question in many different forms: “How can my company operate under the new provisions in the Medicare Modernization Act (MMA)?” To this question, I point to the words of Madame Marie Curie: “Nothing in this world is to be feared. It is only to be understood.” Our country is going through a major upheaval. Events happen almost daily that will affect every business in one form or another, whether it is for higher gasoline prices or additional taxes. None of this matters so long as you are not afraid. You are all businesspeople, entrepreneurs. That fact is confirmed by the successful companies you all run. As I look…
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  • Hobson Drafts Legislation To Repeal 2005 Reimbursement Cuts

    Washington A U.S. Representative plans to introduce legislation that would repeal 2005 reimbursement cuts for some DME products and oxygen. The Medicare Modernization Act (MMA) implements the cuts next year for manual and power wheelchairs, nebulizers, diabetic supplies, air mattresses and oxygen. Cuts will be based on an Office of Inspector General (OIG) report on Federal Employees Health Benefits Plan (FEHBP) median pricing and a forthcoming OIG report on home oxygen and oxygen equipment. But Rep. David Hobson, R-Ohio, said he wants to stop the cuts from happening. In a letter to House Speaker Dennis Hastert, R-Ill., and Rep. Bill Thomas, R-Calif., former chairman of the Medicare Conference, Hobson said he planned to draft legislation to rescind the reimbursement-cut provision in MMA. “I continue to…
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  • Houston Psychiatrist Convicted In PWC Fraud Scheme

    Houston On April 1, Houston psychiatrist Lewis Gottlieb was convicted for his involvement in a multi-million-dollar power wheelchair billing scheme uncovered last year. The psychiatrist defrauded Medicare and Medicaid of $16 million by approving hundreds of motorized wheelchairs for beneficiaries in return for kickbacks from wheelchair suppliers. Indicted last September, Gottlieb pleaded guilty to executing a health care fraud scheme and receiving kickback payments between October 2001 and May 2003. He now faces a maximum penalty of 10 years in federal prison for the health care fraud conviction, five years for the illegal kickback conviction and another five years for the conspiracy conviction. Sentencing is set for June 24. During last month’s hearing, Gottlieb admitted to signing hundreds of CMNs in exchange for $200 per…
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  • DME Competitive Bidding Back on the Table in Florida

    Tallahasee, Fla. For the third time in three years, competitive bidding for Florida Medicaid DME business is back in play. The current proposal, stated as proviso language in state appropriation bills, asks for a contract on Medicaid DME — excluding customized wheelchairs, colostomy and ostomy supplies, orthotics and prosthetics — with payments no more than 80 percent of current Medicaid rates. “The bid [would] begin at a 20 percent reduction and go from there,” said Javier Talamo, director of political services at PediStat, a Miami provider of pediatric DME and services. The proposal says DME providers should “bid on services like ventilator care and high-tech pediatric care, which by their complexity should be [acquired] on a capitative basis,” he said. “[The proposal] deprives the [beneficiary]…
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  • Are You on the NSC’s Naughty or Nice List?

    DME suppliers face an era of increasing scrutiny from the government. As Medicare and Medicaid reimbursements drop and the government commences various reform initiatives (including competitive bidding), the National Supplier Clearinghouse (NSC) has begun increased oversight of providers, both new applicants and those already up and running. Even though the catalyst for such scrutiny may have been the recent Medicare billing scheme involving power mobility equipment, the NSC has always been required to perform periodic supplier audits to verify continued compliance with the CMS 21 Supplier Standards. So, long after the power wheelchair scandal is considered old news, NSC scrutiny will continue. These days, you do not have to engage in fraudulent activities in order to be in the hot seat. The NSC seems to…
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  • Getting Rid of the FEHBP-Based Cuts

    The quintessential Washington wisdom this year is that of all election years — it will not be an active legislative season. So the HME industry must use this time to enlist political support for the objectives we have, both short-term and long-term. Although it appears all attention is focused on the presidential election, Congress is still charged with a number of must-do actions this year. As an industry, we simply have too many issues on our plate to be politically complacent. Think of the sheer number of issues imposed on our industry by the Medicare Modernization Act (MMA). We cannot afford to sit on the sidelines. In the short term, we are faced with reimbursement cuts for five categories of DME slated for January 2005…
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  • Accreditation Summit Draws a Crowd

    The American Association for Homecare’s “Accreditation Summit” at Medtrade Spring featured representatives from ACHC, CHAP and JCAHO. For information on how to begin the accreditation process or how to choose an accrediting organization, see “Mandatory Accreditation” by Jerold S. Cohen, president, Caesar Cohen Ltd. (HomeCare, February 2004) and “Getting Accredited and Doing It Now” by Tom Caesar, president, ACHC (HomeCare, March 2004). You can contact the following accrediting bodies directly or visit their Web sites at: Accreditation Commission for Health Care (ACHC), 919/785-1214, www.achc.org; Community Health Accreditation Program (CHAP), 609/463-CHAP; Joint Commission on Accreditation of Healthcare Organizations, 630/792-5000, www.jcaho.org.
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  • Wake Up to Billing for Sleep Apnea

    In 2002, the DMERCs changed coverage policies for CPAPs and supplies to treat those diagnosed with obstructive sleep apnea (OSA). These changes opened the doors to many who could not receive treatment under the old policy. Now, continuous positive airway pressure devices (CPAPs) — HCPCS code E0601 — are covered for patients diagnosed with OSA documented by a facility-based, attended polysomnogram (sleep study) and who meet either of the following criteria: (1) The apnea hypopnea index (AHI) is greater than or equal to 15 events per hour, or (2) The AHI is from five to 14 events per hour with documented symptoms of (a) hypertension, history of stroke or ischemia heart disease; or (b) excessive daytime sleepiness, impaired cognition, mood disorders or insomnia. Correct Documentation…
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  • Avoid the Compliance Panic Virus

    Some health care companies treat “the rules” like viruses that spread panic and confusion within organizations. This seemingly infectious bug — the “compliance panic virus” — causes a dreaded disease: Rule Overload. But there is a vaccine for this disease. One key prescription is training, but not specific training in HIPAA rules or anti-fraud rules or Medicare reimbursement rules. Rather, the cure is to teach your personnel how your day-to-day operational policies and procedures already address these rules. The “rules” require you to have compliant policies and procedures, but they do not require that you teach or learn the hundreds of pages of regulatory rules. Instead, teach your staff how to follow your company’s policies and procedures, how these policies and procedures deal with the…
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