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Legislation & Regulation

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

  • How Bad Is It, Really?

    Is the Medicare Prescription Drug, Improvement, and Modernization Act of 2003 better or worse than we expected? How will it affect your company? Our lawyer friends would answer, “It depends.” There are some effects that we can quantify and that prove the lawyers’ answer right. For example, 13 million seniors not previously covered will get prescription drug coverage. Retail pharmacies will register a net increase in sales of about $12 billion in 2004 — a 6 percent jump that will grow at 13 percent per year. So, is it all bad if your company is a pharmacy or a combination pharmacy and durable medical equipment provider? Out-of-pocket spending for drugs by seniors is currently about $11 billion per year. Seniors will reallocate some of that…
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  • Going Up

    Welcome back to Compliance University. Class is now is session! “Rule Overload” is reaching crisis proportions. Home medical equipment suppliers are “at the end of their ropes” from the stress of trying to keep track of and comply with the rules that govern the industry. The ROPE (Rule Overload Prevention and Elimination) System is a solution to Rule Overload that is premised on this common-sense idea: You need to run your company in a manner that achieves all of your goals, not just “obeying the rules.” We’ll use the metaphor of a “ROPE Ladder” with five rungs for this climb to success. These five rungs help you create effective operating systems for your company that facilitate your goals in general. In other words, the ROPE…
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  • Latest Legislation & Regulation News

  • Sit Tight

    By the time this issue of HomeCare goes to press you will have read many articles about the Medicare reform bill, or Medicare prescription drug plan, that will be going into effect, in part, this month. I have examined what the doomsayers predict. I have reviewed what the politicians think they have produced. I must admit, I am confused. These last few weeks I have received many telephone calls asking me what I feel the dealers should do. My answer is, “Sit tight.” We are very fortunate to have an association as effective as the American Association for Homecare leading the charge. They have your best interests in mind and are working very hard to rectify some of the obvious faults in the program. Here…
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  • At the Head of the Troops

    For more than 12 years — and 25 if you count his experience in policy-making positions at various local, state and federal levels — David T. Williams has devoted his career to changing governmental policy for the benefit of home medical equipment providers, manufacturers and consumers. His co-workers and peers say Williams ranks among “the best minds in the industry” when it comes to developing and implementing strategies to influence the regulatory and legislative processes that govern the industry. And it is for his deep commitment to the industry that judges of HomeCare‘s HomeCaring Awards for 2003 chose Williams as a recipient of the honor. While much of his involvement takes place behind the scenes, in one clear example of his personal diligence, Williams sought…
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  • Editor’s Inbox

    HME Providers “Set Up”To Take Fraud Fall There is nothing competitive about competitive bidding. It is just a tool for CMS to eliminate providers, fix prices and control fraud and abuse. Over the years, I have noticed that there seems to be an increase in the number of fraud cases uncovered by the FBI and OIG when there is some legislative change in the works. It is like they need to prove to everyone that what they are about to do is needed: “See! Look at the fraud! Now, take the punishment!” Interesting, isn’t it? The real rub of all of this is that the system is set up to allow an investigation of any one of us to result in an indictment. The paperwork…
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  • Bush Signs Medicare Reform Bill As Industry Braces for Impact

    Washington After a months-long battle on Capitol Hill, President Bush signed Medicare reform legislation into law Dec. 8. Among its provisions, The Medicare Prescription Drug, Improvement, and Modernization Act of 2003 mandates a five-year Consumer Price Index freeze for DME beginning this year. It phases in DME competitive bidding in the nation’s top 10 metropolitan statistical areas in 2007 with expansion to the top 80 MSAs in 2009, after which the Department of Health and Human Services could extend competitive bidding nationwide. Beginning in 2005, the Medicare reform law calls for reimbursement cuts on a string of items, including oxygen, wheelchairs, nebulizers, diabetic suppplies, hospital beds and air mattresses, based on the Federal Employee Health Benefits Program (FEHBP) median. The new law also reduces reimbursement…
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  • NCSL Health Committee Proposes Medicaid Reform Platform

    Washington At the National Conference of State Legislatures’ fall forum last month, the organization’s health committee outlined its platform for controlling state Medicaid costs. Now that Medicare reform has been accomplished, NCSL representatives said they anticipate that Congress and the Bush administration will turn attention to reform of Medicaid. Among major elements of the strategy is a call for the federal government to begin counter-cyclical financing, which would automatically boost federal Medicaid payments to states during economic downturns. The platform announcement follows several NCSL survey reports describing how states have altered their Medicaid programs during the past two years of budget turmoil, and how they plan to alter them in the future. According to State Medicaid Actions: A Two-Year Review of State Actions as a…
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  • Lessons Learned

    As the dust settles on Medicare-reform legislation, it is not too early to examine what we, the home care industry, accomplished this year and where we fell short of the mark. This year’s experience provides us with valuable lessons for 2004. This year we were more successful than ever in turning members of Congress into not just supporters, but advocates for home care issues. Rep. Dave Hobson, R-Ohio, led the charge in the House of Representatives, boldly declaring to Rep. Bill Thomas, R-Calif., and chairman of the Medicare Conference Committee, that he would vote against the Medicare drug package if it included competitive bidding (In a twist, Hobson eventually voted for the bill). We were also successful in garnering significant support on the Senate side….
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  • A Thanksgiving Turkey

    Just hours after the U.S. House of Representatives passed a sweeping Medicare reform bill on Nov. 22, political commentator Al Hunt told comrades on CNN’s “The Capital Gang” that it was appropriate the measure had passed during Thanksgiving week because, he said, this bill “is a real turkey.” While Hunt was addressing his concerns about the gutted benefits and high costs associated with the controversial legislation, which passed the Senate three days later, his quip was particularly fitting for those portions of the package that deal with DME. Though the final version of the bill will require interpretation (as legislative language so often does), the major points on DME are clear: There will be a CPI freeze on DME beginning next year, followed by phase-in…
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  • Medicare Reform Bill Passes, Includes Competitive Bidding

    WASHINGTON — After months of intense debate and political infighting, including a pre-dawn vote in the House of Representatives and a day-long showdown in the Senate, Congress passed a sweeping Medicare reform bill in late November. At press time, President Bush was expected to sign the measure into law on Dec. 8. Negotiated in conference committee since the summer, the final version of the reform package is a compromise agreement that gained late favor after endorsement by AARP, the powerful seniors group with 35 million members. The main component of the legislation, which marks the first major overhaul of Medicare in its 38-year history, is a new prescription drug benefit for the 40 million beneficiaries now covered by the vast government program. But the bill’s…
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  • AAHomecare Responds to National Wheeler Dealer Article

    Alexandria, Va. The American Association for Homecare reiterated its opinion that there should be “zero tolerance” for Medicare fraud and abuse involving power wheelchairs, in response to a Nov. 12 Associated Press news article that detailed 50 separate power wheelchair fraud investigations launched as part of the government crackdown known as “Operation Wheeler Dealer.” The AP article noted that the durable medical equipment industry aggressively markets power wheelchairs, adding that the number of Medicare power wheelchair claims rose from about 55,000 in 1999 to almost 170,000 this year. In response, AAHomecare said it views the increase in claims as a positive development. “As wheelchair technology has improved and the beneficiary population has aged, this increase is a clear sign that more and more Americans are…
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  • Building Your ROPE Ladder

    Welcome back to Compliance University. Class is now in session! Let’s explore solutions to the problem of “Rule Overload,” which we defined last time. Rule Overload afflicts the majority of health care providers who approach compliance from a “learning the rules” perspective. Instead of keeping track of all the rules, the ROPE System is a new method for achieving Rule Overload Prevention and Elimination that incorporates rule-compliant behavior into your existing operational systems — billing, warehousing and maintenance, delivery and set-up, medical records, contracting and marketing, and so forth. This is a new way to view compliance. Forget the “rules.” Just make sure your own systems run as you intend them to run! So, how can you subsume the concept of “compliance” into your own…
    Read More →: Building Your ROPE Ladder

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