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Legislation & Regulation

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

  • Beware of Marketing Ploys that Misuse Medicare, OIG Warns

    Washington Posing as a government-sanctioned program, without federal permission, is against the law, the U.S. Office of Inspector General warned health care consultants and providers April 8. To emphasize this message, the OIG fined the officers of U.S. Seminar $1.1 million for using the term “Medicare” misleadingly in marketing materials the company mailed to more than 300,000 health care providers. “In many instances, you sent a series of three solicitations to providers,” the OIG told the company’s president, vice president and sales manager. “The first of these mailings was a blue brochure describing that the solicitation was ‘formal notice of a workshop detailing local [state] Medicare changes.’ The solicitation refers to ‘Medicare Special Bulletin B-89-23’ and states that ‘compliance is required.’” Follow-up solicitations from U.S….
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  • Budget Options Include NCB and Drug-Payment Cuts

    Washington Some of the nation’s most influential number crunchers — those who work at the U.S. Congressional Budget Office — March 3 published a budget-cutting handbook of sorts for lawmakers on Capitol Hill. The report, titled “Budget Options,” includes nearly 300 pages of savings suggestions, and targets home medical equipment specifically. For example, the federal government could save as much as $3.6 billion between 2004 and 2008, if Congress cut reimbursements for Medicare Part B drugs, the report said. Currently, Medicare reimburses these drugs — which include respiratory and infusion medications — at a rate of 95 percent of the “average wholesale price.” However, the CBO believes that rate is not what providers pay for drugs,” and suggests reducing the reimbursement to 85 percent of…
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  • Latest Legislation & Regulation News

  • Lincare Pharmacy Faces Injunction, Spurs Regulatory Action

    Kansas City, Mo. Med 4 Home — a compounding pharmacy that allegedly failed to comply with Missouri rules regarding the recall of contaminated drugs — has spurred regulatory activity that could threaten the viability of small compounding pharmacies throughout the state, according to the International Academy of Compounding Pharmacists. The story became public March 10, when the Missouri Board of Pharmacy asked a judge to issue a temporary restraining order against Med 4 Home, a subsidiary of Clearwater, Fla.-based Lincare. “Board investigators determined that Med 4 Home had not followed proper recall and notification procedures for a batch of albuterol/ipratropium solution it had compounded,” said Kevin Kinkade, the board’s executive director. “Quality assurance tests conducted by the pharmacy revealed contamination in at least two lots…
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  • House Passes $93 Billion in Medicaid Cuts, Final Budget in Conference

    Washington By a vote of 215 to 212, the U.S. House of Representatives March 20 passed a 2004 budget resolution that contains approximately $93 billion in Medicaid cuts. Although the final resolution was less severe than its predecessor — which recommended $215 billion in cuts to both Medicaid and Medi-care — it still could hurt the home care industry, according to Seth Johnson, director of public policy at the American Association for Homecare. “These cuts would make it very difficult for our legislative proposals that cost any amount of money,” Johnson explained. Additionally, “programs like competitive bidding could be an alternative they would look at more closely.” AAHomecare’s hopes of defeating such cuts now rest in the Senate, where lawmakers passed a 2004 budget resolution…
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  • National NewsWire

    Legislative: Governors Call for Medicaid Reform: Struggling to address Medicaid shortfalls that have reached crisis proportions, the House Energy and Commerce Committee March 12 heard testimony from three governors: Jeb Bush, R-Fla.; John Rowland, R-Conn.; and Bill Richardson, D-N.M. Currently on the table is a proposal from the Bush administration, which would provide states with more flexibility to make Medicaid coverage decisions. Short term, the proposal would offer extra cash to states that chose the more-flexible plan but would cap federal outlays after seven years. While Governors Bush and Rowland generally supported the administration’s proposal, Bush expressed concerns about whether the proposal would recognize population growth. By contrast, Governor Richardson said the administration’s plan shirks federal responsibility. Bush Medicare Plan Could Narrow HME Playing Field,…
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  • HIPAA, The Sequel

    It’s April 2003, the month that those of us in the health care industry — some of us, anyway — have been counting down to for more two years. The definitive April 14, 2003, deadline has arrived for home care providers, insurance companies and other health care providers to be in compliance with the new federal Health Insurance Portability and Accountability Act privacy rules. By now your organization should have developed and implemented HIPAA privacy-specific policies and procedures that describe how you maintain the confidentiality of protected health information, or PHI. Additionally, you should have trained your employees on those policies and procedures. Finally, you should have begun providing your organization’s Notice of Privacy Practices to new patients. For those of you who have completed…
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  • Why Bother?

    Welcome to Compliance University! This month we continue to challenge common compliance-related wisdom by acknowledging and demanding an answer to The Question They Dare Not Ask: “Why should I bother with a compliance program?” Our premise is this: Any home care provider that does not have a working, effective regulatory compliance program has, in effect, decided not to bother with compliance initiatives. In other words, the provider has decided that the benefits of an effective compliance program are not worth the costs and hassles of implementing the program. All types of providers engage in this sort of denial. Medical groups, ancillary service providers, long-term care organizations and even hospitals join many home care providers in electing to operate without a real compliance program in place….
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  • National News Wire

    Regulatory: CMS Publishes Contractor Standards: The Baltimore-based Centers for Medicare and Medicaid Services Feb. 25 published an announcement in the Federal Register, describing the criteria whereby Medicare will evaluate its durable medical equipment regional carriers during 2003. “The results of [these] evaluations are considered whenever we enter into, renew or terminate a … DMEPOS regional carrier contract or take other contract actions,” the Centers for Medicare and Medicaid Services wrote. Although the proposed standards — which include criteria for claims processing, customer service and fiscal responsibility — took effect March 3, CMS will accept comments on the standards until March 31. More information about these standards is available at www.access.gpo.gov/su_docs/fedreg/a030228c.html, under the CMS heading. FDA Publishes Device User-Fee Rates: The Feb. 28 Federal Register included…
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  • Congressman Urges Oversight of JCAHO

    Washington The organization that oversees the activities of countless health care providers — including hospitals, home medical equipment companies and home health agencies — could use some oversight of its own, Rep. Pete Stark, D-Calif., told the U.S. Office of Inspector General Jan. 15. Pointing to what he deems ineffective hospital surveys, a conflict of interest between consulting and surveying functions, and anonymous contributions, Stark asked the OIG to investigate certain practices at the Oakbrook Terrace, Ill.-based Joint Commission on Accreditation of Healthcare Organizations. Commenting on Stark’s request, JCAHO asserted its willingness to cooperate with the OIG. “[We] welcome an evaluation by the [OIG] at any time,” the organization said, pointing to a 1998 report that found JCAHO’s processes to be satisfactory. “Indeed, the Joint…
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  • Why Bother?

    Welcome back to Compliance University! Today we apply fresh, new perspectives to The Question They Dare Not Ask: “Why should I bother?” In December, I established the premise that any home medical equipment provider without a working regulatory compliance program is, in effect, deciding that there is no need to bother with compliance. This phenomenon certainly is not limited to HME providers. Medical groups, ancillary service providers, long-term-care organizations and even hospitals continue to operate without compliance programs in place. Last time, I presented six reasons to bother with a compliance plan, focusing on staying out of trouble with the government. While these reasons certainly are important, too often they are the only issues that providers consider. In fact, there are at least 12 additional…
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  • Congressional Outlook

    With the prospect of war on the horizon, it is hard to be excited about watching what will unfold domestically in 2003. Nonetheless, a major part of our population will be focusing intently on Washington as President Bush attempts to address both domestic issues and international crises while initiating his own re-election campaign. The President’s Jan. 28 State of the Union address was one of the more interesting that I have witnessed. It was full of surprises — initiatives for developing a hydrogen-powered car, assisting those suffering from addiction and providing medicines to AIDS victims in Africa — balanced with strong and determined words about the situation in Iraq. The President seemed to say that the United States would provide compassionate assistance to those in…
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  • Medicare’s Saviors?

    Like eager boy scouts who offer to usher an elderly woman across the street, federal lawmakers are lining up to guide Medicare into the 21st Century. The Democrats are reporting that, while the elderly woman would like to have help with her grocery bag, she otherwise is “just fine, thank you.” Republicans are insisting that, without substantial help, the elderly woman might never make it across the street. Both parties are promising to add a prescription drug benefit to Medicare, but Republicans say that radical reform must accompany any such benefit. Away from the glare of television-camera lights, lawmakers on both sides of the aisle admit that budget cuts are inevitable. If history has taught the home medical equipment industry anything, it is that Congress…
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