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Legislation & Regulation

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

  • Just More to Overcome, Not a Call to Exit

    OK. Among the many things home medical equipment providers were grateful for on Thanksgiving, Congress probably did not make the list. But come Monday morning, after a couple of “why me’s?,” and perhaps a dose of Prozac with a Starbucks chaser, HME owners across the country got around to what they do best — adapting and thriving. Here are a few reasons why the new Medicare Prescription Drug, Improvement, and Modernization Act (MMA) won’t send providers screaming into the night. As Bad as the Bill Is — and It’s Bad — It’s Not That Bad Other than the dramatic change in nebulizer reimbursement from discounts off Average Wholesale Price to a new model of Average Sale Price plus a paltry 6 percent (which clearly took…
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  • Look Upon the Doughnut

    The last few months have been trying times, filled with much confusion, with information changing daily, with regulations that we all have difficulty understanding. It seems that the bureaucrats in Washington, D.C., are having difficulty in finding a common approach to Medicare, to Medicaid, to Social Security, to a rapidly rising national debt and to resolving our difficulties with terrorists. While the government’s recent actions have had a detrimental effect on the average DME/HME dealer, HHAs and most other health practitioners, this is not the time for sackcloth and ashes. On the contrary, now is when you have to restructure your plans for the future. Throughout this issue of HomeCare, you’ll find lots of suggestions from the experts on how to prepare your business for…
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  • Latest Legislation & Regulation News

  • Expect the Inevitable

    Some things are just so predictable. We can be sure summer is coming, that we will get older and that there will be days when our patience will be put to the test. In the home care business, we also have certain predictables — one is that someone is going to toy with our reimbursement rates. Could HME be the most misunderstood segment of the health care industry? It’s possible, and it appears that this misunderstanding will continue. What we do know is that we must prepare for a changing health care landscape. However, providers should not let the present environment frustrate sales efforts to meet the needs of a tremendously growing market, or efforts to reach potential customers. The revenues are out there, but…
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  • Letters to the Editor

    No Tears Here We in the industry do not cry crocodile tears over The Scooter Store’s lamentations (“Scooter Store Lays Off 200,” February 2003). I am sure that the store’s ads have been in no small part responsible for Medicare’s increased scrutiny of power wheelchair claims. The Scooter Store has predicated its business model on the fact that Medicare has not been aggressively auditing providers of power mobility products. Many of us in the industry have been well aware of both Medicare’s regulations regarding the ambulatory status issue and the fact that, quite frankly, many claims for these items have been improperly paid due to “holes” in the DMERCs’ edit/audit systems. When you use phrases such as “we guarantee Medicare coverage, or you pay nothing,”…
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  • Bush Calls for Improved Health Care Access

    Washington During his State of the Union address Jan. 20, President Bush called on Congress to help control health care costs and, at the same time, “extend the benefits of modern medicine” throughout the country. He also praised the Medicare Prescription Drug, Improvement, and Modernization Act that he signed into law in December. Among other priorities, the president’s speech proposed: In a statement issued following the address, the American Association for Homecare, Alexandria, Va., supported the president’s “vision for the future of America’s health care” but expressed concern about how Medicare’s overhaul will affect beneficiary access to care. “This is especially true as it relates to durable medical equipment, and the changes imposed on the home health and rehab sectors,” AAHomecare said. For breaking news,…
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  • Industry Stakeholders Fight DMERC Power Wheelchair Clarification

    Washington In response to the policy clarification on power wheelchairs issued in December by the four DMERCs, industry stakeholders continue their opposition and have requested an open dialog with the Baltimore-based Centers for Medicare and Medicaid Services on the issue. According to the DMERCs’ new clarification, power wheelchairs will be covered only for “patients who are non-ambulatory.” (See “The Scooter Store Lays Off 200,” page 8.) Industry advocates have also said that the clarification’s medical review guidelines may be applied retroactively. “The application of these new policies to beneficiaries who have already received power wheelchairs that met the previously accepted coverage criterion will cause irreparable harm to both beneficiaries and suppliers,” said American Association for Homecare President and CEO Kay Cox. In a December letter…
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  • Court Blocks California Medicaid Reimbursement Reductions

    Sacramento, Calif. Citing potential beneficiary access problems, a federal judge granted a preliminary injunction in December blocking provider cuts to Medi-Cal, the California Medicaid program, that were slated to go into effect Jan. 1. The cuts were part of a compromise budget proposal passed last summer by the state legislature and signed by then-governor Gray Davis. For California HME providers, the ruling affects those who sell disposable medical supplies such as incontinence supplies, said Bob Achermann, executive director of the California Association of Medical Product Suppliers (CAMPS). A 5 percent reduction of DME was “discretionary for the [California Department of Health],” he said. The department has not said it would enact the reductions yet, and they probably will not do so, he explained, “because of…
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  • Crossover Billing Begins For N.Y. Dual Eligibles

    Albany, N.Y. In December, the New York State Department of Health implemented a new procedure for billing Medicaid for Medicare co-insurance and deductible amounts for dual eligibles, or those eligible for both Medicaid and Medicare. The procedure follows state statutory changes enacted July 1, which reduced reimbursement to 20 percent of the 20 percent co-insurance cost, essentially representing a 16 percent cut, according to the New York Medical Equipment Providers association. For example, if a DME product costs $100, Medicare will pay $80, and the state’s Medicaid program will only reimburse $4 of the remaining $20 co-insurance, leaving $16 for the provider to absorb. Excluding pharmacy drug claims, according to NYMEP, the procedure is effective retroactively for dual-eligible claims submitted with dates of service on…
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  • Redefining Rehab: From State House to Capitol Hill

    In 2003, Tennessee became the first state to mandate certification for HME dealers when fitting individuals in wheelchairs for long-term use. Now known as “consumer protection” legislation, the law is a good beginning, according to Darren Jernigan, director of government affairs for Lebanon, Tenn.-based Permobil, which was instrumental in drafting the legislation and hopes to encourage other states to follow Tennessee’s lead. While provisions in the Medicare Prescription Drug, Improvement, and Modernization Act of 2003 make accreditation mandatory for providers reimbursed by Medicare, state laws would require certification for individuals and would apply to all providers, whether they do business with the government or not. “Requiring that a consumer who needs a wheelchair for long-term use be seen by a person with credentials in seating…
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  • Are You Prepared for a Motorized Mobility Audit?

    If the DMERCs were to audit your K0011s (motorized wheelchair with programmable controls) and/or your E1230s (power operated vehicles/scooters), would you survive the audit? As part of the government’s 10-point plan to curb fraud and abuse in this market, the local medical review policy (LMRP) was reviewed carefully, giving consistency on how the DMERCs will audit and reimburse for these items. Not only will there be pre-payment reviews, there will be numerous post-payment reviews to verify that the provider should have been paid based on the documentation obtained. For K0011s and E1230s, Medicare will apply the national policy on old as well as current dates of service. The policy states that a “patient must be bed- or chair-confined without the use of a wheelchair, and…
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  • Doing Things Your Way

    The ROPE (Rule Overload Prevention and Elimination) system reduces “rule overload” while improving profitability and operational efficiency. Complying with the system requires climbing a ROPE ladder with five rungs. The first rung consists of three strands woven together: (1) Articulate how you want your systems to run and note, dispassionately, how they in fact do run; (2) identify whether the way you want to do things needs to be modified to satisfy legal rules; (3) and, finally, write down the operating policy. A Draft Policy But does this first rung really work? To find out, try running a preliminary test by creating a draft equipment purchasing policy. Start with questions. How do you purchase equipment? Do you have a standing order for minimum inventory? Do…
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  • Prescription for Change

    It’s been a few weeks since Dec. 8, when President Bush signed the Medicare Prescription Drug, Improvement, and Modernization Act of 2003 into law. With regard to its impact on the home medical equipment industry, this is, without a doubt, the most devastating package of legislation ever passed by Congress. The following summary details some of the many HME-related provisions in the new law and explains the potential impact of those provisions on individual providers and the industry as a whole. Mandatory Accreditation The U.S. Dept. of Health and Human Services will establish and implement “quality standards” to be applied by independent accreditation organizations. Durable medical equipment suppliers must comply with these standards in order to furnish DME to Medicare beneficiaries and to receive and…
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