Senator Arlen Specter (R-Pa.), the American Association for Homecare, other homecare stakeholders held a meeting with Centers for Medicare and Medicaid Services (CMS) Acting Administrator Kerry Weems. The meeting focused on Medicare program integrity, power mobility issues, the new competitive acquisition program, and home oxygen therapy.
Tyler J. Wilson, president of the American Association for Homecare, commented after the meeting, "We talked about our frustration that CMS has not taken more measures to strengthen program integrity in Medicare and to stem fraud at the front-end. We told the Administrator that we want to collaborate to prevent fraud from happening in the first place."
Wilson noted that the fraud and abuse CMS encountered in Florida earlier this year could have been prevented by site visits from the National Supplier Clearinghouse or from accrediting bodies. Wilson said the meeting was positive and that Weems acknowledged that fraud is not coming from mainstream providers in the home medical equipment (HME) industry.
Several specific recommendations were made to Administrator Weems with respect to program integrity:
- CMS should immediately announce a final date by which all homecare providers in Medicare must be accredited.
- Quality standards should be further strengthened. The American Association for Homecare recommended more stringent standards than the ones that were finalized by CMS last year. The second draft of standards now being developed by CMS should raise the bar for all product categories identified in the three appendices.
- CMS should instruct staff who oversee the Medicare durable medical equipment program to spend a day with a home medical equipment provider to see how the current system works in the real world.
On power wheelchair issues, the American Association for Homecare stated that new power mobility device (PMD) codes and coverage policy have reduced Medicare spending by 27 percent. The reduction in payment rates and new coverage policy appear to have substantially decreased utilization of the benefit. PMD utilization is currently trending more than 30 percent below the CMS estimates of 243,000 reimbursed PMDs in 2007, resulting in an estimated49-51 percent reduction in total spending for PMDs this year. The group expressed concern that the PMD policy is harming patient access to power wheelchairs.
Specific recommendations to Weems regarding power mobility included the following:
- Exclude product categories for standard and complex power rehabilitative power wheelchairs and accessories from the first round of the Medicare competitive acquisition program for durable medical equipment.
- Create PMD policy documentation requirements and issue updated education and training for physicians and suppliers. Clearer and more practical documentation requirements must be developed and communicated from CMS to physicians/clinicians and suppliers.
- Work with industry stakeholders to provide much needed clarity, guidance, and education about the Medicare documentation requirements.
AAHomecare also pressed for a closer examination of service-related components of oxygen therapy and said it is pleased that CMS is not opposed to a repeal of the transfer of ownership of oxygen equipment to the beneficiary after 36 months.
In addition to Specter and Weems, participants included Tyler J. Wilson; Alan Landauer of Landauer Metropolitan, who is Chairman of the Association; Seth Johnson from Pride Mobility; Georgie Blackburn from Blackburn's Physicians Pharmacy, who serves as AAHomecare Treasurer; Don Clayback from the MED Group; Don Bates from Fuller Rehabilitation in Ringgold, Ga.; and Eric Sokol from the Power Mobility Coalition.
Calendar
November is National Homecare Month
November 14 is World COPD Day
For details, see Global Initiative for Chronic Obstructive Lung Disease: goldcopd.
American Association for Homecare Washington Legislative Conference, March 4-6, 2008
aahomecare
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