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Legislation & Regulation

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

  • No HIPAA Delay, Committee Urges

    Washington The National Committee on Vital and Health Statistics last month advised the U.S. Health and Human Services Department not to delay the “transaction and code set” deadline of the Health Insurance Portability and Accountability Act. In a letter to HHS Secretary Tommy Thompson, the committee explained that delaying the Oct. 16, 2003, deadline would punish those who are following the rules. “The committee feels that … it’s important to proceed with implementation,” said a staff member for the NCVHS. Softening the impact of this resolute stance, the committee recommended that HHS allow “substantial flexibility,” as covered entities work to come into compliance. Such non-punitive language echoed a message that a representative from the Centers for Medicare and Medicaid Services delivered to attendees at a…
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  • Face to Face with Reimbursement

    Washington’s face may not have launched a thousand ships, but it certainly prompted thousands of HME providers to brave the seas of reimbursement over the past year. For some, the voyage was short, yielding approvals at every turn. For others, the voyage never ended, as denied claims piled up, payments stalled and the HIPAA deadline grew closer. The following pages hold snapshots from those voyages, provided by a few hundred of your peers. In May, HomeCare mailed reimbursement questionnaires to 1,500 randomly selected domestic subscribers, asking about denials, appeals, days sales outstanding, third-party payers and more. Many of the respondents were small, full-service HME providers. In fact, of the 353 participating businesses, 40.5 percent reported annual revenue of less than $1 million. Another 41.3 percent…
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  • Latest Legislation & Regulation News

  • Grassley’s DME Cuts Don’t Make the Cut

    Washington Senate Finance Committee Chairman Charles Grassley, R-Iowa, has made no secret of the fact that rural health reimbursements are his top priority. Last month, he kept a promise to introduce legislation to help rural Medicare providers “at every opportunity.” But Grassley’s plan came at a cost — and, under the provisions of a recent amendment, the durable medical equipment industry was slated to bear some of that cost. Not waiting for a health-care-related bill to come along, Grassley added a $25 billion rural health care amendment to the Senate’s tax bill, and included two DME cuts to offset the expense. The first cut would freeze consumer-price-index increases for DME for 10 years. The second would reduce reimbursements for Medicare Part B drugs, from 95…
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  • Rotech Raid Sparks Speculation, Concern

    Orlando, Fla. Agents from the Federal Bureau of Investigation April 30 raided Rotech’s headquarters in Orlando, as well as company offices in Maine, New York, Arkansas and Illinois, according to WFTV, an Orlando television station. Approximately 50 agents took part in the Orlando raid, removing “boxes and boxes of documents,” WFTV reported. One day later, Rotech released a statement confirming the raids and explaining that the company does not know the reason for the investigation. “The company is cooperating fully with the investigation,” the statement said. “However, [Rotech] has not been informed by the government of the subject matter of the inquiry.” Federal investigations are not new for the HME giant. Last March, Rotech paid $17 million to settle allegations that, between 1995 and 2000,…
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  • HIPAA Security

    Welcome back to Compliance University! Since our last session, the Health Insurance Portability and Accountability Act’s privacy provisions have taken effect, and most of you have the necessary policies in place. Some of you (the wiser ones, in my opinion) are beginning to realize that it is not enough to know “the rules.” But if HIPAA compliance is not about the rules and the policies, what is it about? The secret is to create a system to manage compliant procedures. Then, run the system, don’t run the rules. Teach the procedures, don’t teach the law. Monitor the activity, don’t monitor the words. At its core, an effective compliance program is a “systems management” program with a few key elements. To create the system, you should:…
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  • Legislative Lowdown

    Las Vegas Some of Medtrade Spring’s most popular conferences covered legislative and regulatory topics, explaining the prospects for national competitive bidding, the status of “inherent reasonableness” regulations and the progress of state licensure laws. Attendees filled the chairs, lined the walls and sat on the floor at the American Association for Homecare’s legislative update conference. Following are summaries of a few of the legislative and regulatory subjects that AAHomecare staff members discussed: DME Competitive Bidding — Tom Connaughton, AAHomecare’s president, said the home care industry was fortunate to escape DME competitive bidding last year, after President Bush’s 2003 budget and a successful bill in the House of Representatives touted the system as a viable way for the federal government to save money. There are many…
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  • State NewsWire

    Noteworthy OIG Says State Medicaid Agencies are Ready for HIPAA: After conducting telephone interviews with officials from the 51 state Medicaid agencies, the Washington-based U.S. Office of Inspector General determined that most states are on track to meet the electronic-data-interchange standards of the Health Insurance Portability and Accountability Act. The deadline for compliance is Oct.s 16, 2003, and 42 agencies — representing approximately 80 percent of states — anticipate they will meet that deadline, the OIG reported. Among the barriers to HIPAA compliance are dwindling financial resources and technical support, regulatory delays, changing federal regulations and inconsistent interpretations, the states reported. More information about this survey is available at http://oig.hhs.gov. Georgia Class Action Lawsuit Alleges ADA Violation: Seven individuals who, because of their disabilities, were…
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  • Congressional Outlook

    Against the backdrop of war, Congress is trying to go about its regular business. At this writing, both houses are working to pass budget resolutions for 2004. Fortunately, the House of Representatives’ budget resolution, which originally called for severe cuts in Medicare, has been modified so that Medicare is protected. This favorable change came about as a result of the strident protests of health care providers and suppliers, including the American Association for Homecare and its members. Although the nearly evenly divided Senate just passed a budget resolution, whether that resolution can be reconciled successfully with the House version is questionable. However, whether or not a budget resolution is finally enacted, and no matter what that resolution contains, we can expect Congress to attempt to…
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  • AAHomecare Meets with Key Policy Advisors

    Washington One way to influence Congress’ decisions is to convince the policy advisors who provide data to lawmakers. Following this model, the American Association for Homecare last month intensified its lobbying efforts, meeting with representatives from both the Medicare Payment Advisory Commission and the U.S. General Accounting Office, to discuss drug pricing and national competitive bidding for durable medical equipment. AAHomecare first met with representatives from the GAO, the government office in charge of evaluating the success of Medicare’s two DME competitive bidding demonstrations. Representing the Coalition for Access to Medical Services, Equipment and Technology, AAHomecare and several consumer advocates told the GAO that competitive bidding is not good for providers, manufacturers or consumers. “I think we demonstrated to the GAO how complex this issue…
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  • New Budget, Old Debates

    Washington Much to home care providers’ relief, the U.S. House and Senate last month passed a 2004 budget resolution that did not include cuts to Medicare or Medicaid. “The budget does not include a proposed $90 billion in Medicaid reductions,” said Seth Johnson, director of public policy for the Alexandria, Va.-based American Association for Homecare. “This is definitely good, compared to where we were a week and a half ago.” However, Johnson cautioned providers not to take too much comfort in the budget resolution. Even as they return home for a spring recess, lawmakers are writing legislation that could change the Medicare and Medicaid landscapes drastically, he said. Elsewhere on Capitol Hill, cuts to Medicare and Medicaid were on the tips of many lawmakers’ tongues,…
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  • Unannounced JCAHO Surveys on the Horizon

    Oakbrook Terrace, Ill. As part of its shift to a “substantially new” accreditation process, the Joint Commission on Accreditation of Healthcare Organizations is testing an unannounced survey process. Beginning in January 2004, health care providers can volunteer to participate in a pilot program to test the new process, which will take effect for all JCAHO-accredited entities by 2006. “The new accreditation process — dubbed Shared Visions-New Pathways — creates the expectation that each accredited organization be in compliance with 100 percent of the Joint Commission’s standards 100 percent of the time,” said Dennis O’Leary, JCAHO’s president. Already, four hospital systems have volunteered to participate in the pilot program, giving JCAHO permission to conduct three unannounced surveys per year. The incentive for volunteering is good publicity,…
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  • Federal Government Ramps Up for HIPAA

    Washington As of April 14, the federal government expected all of the nation’s health care providers to comply with a massive privacy rule — the first in a series of compliance deadlines associated with the Health Insurance Portability and Accountability Act. Preparing to enforce this deadline, the U.S. Office of Civil Rights is adding eight new employees to its HIPAA staff, bringing the total number of HIPAA enforcers to 31, the OCR announced last month. Despite these additions, “the Office of Civil Rights is not a large office,” said Corrine Parver, a health care attorney and partner in the health law services practice of Dickstein Shapiro Morin & Oshinsky. “The HIPAA police are not going to start trooping around the country enforcing compliance.” Nonetheless, complying…
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