BALTIMORE--“Hugs and kisses.” That is what a number of physicians and others sent CMS last week during a Sept. 3 Special Open Door Forum on exemptions to the accreditation requirement for DMEPOS providers.

“Consider yourself hugged and kissed,” one doctor told the agency's Sandra Bastinelli, as he celebrated the announcement that he would no longer be required to become accredited. The phrase quickly became the impromptu theme of the call.

Bastinelli, division director of medical review and education in CMS' Program Integrity Group, explained that physicians and certain other health care professionals are exempt from accreditation under the Medicare Improvements for Patients and Providers Act, the law that delays competitive bidding. The exemptions include physical and occupational therapists, qualified speech-language pathologists and practitioners, physician assistants, certified registered nurse anesthetists and clinical social workers, among others.

“[MIPPA] states that eligible professionals and other persons are exempt from meeting the Sept. 30, 2009, accreditation deadline unless CMS determines that the quality standards are specifically designed to apply to such professionals and other persons,” Bastinelli said. She added that “CMS will work in collaboration with the medical and professional groups to develop any specific quality standards in the future.”

In July, the American Medical Association and other medical organizations wrote HHS Secretary Michael Leavitt asking for an official exemption. The AMA pointed out that, in spite of the new law's provision, CMS continued to apply the accreditation requirement to some physicians who supply DMEPOS to their patients.

Orthotists and prosthetists are also exempt, Bastinelli said, at least for now. She noted CMS plans to publish a notice of proposed rulemaking in 2009 that will address quality standards for orthotic and prosthetic providers. “In 2009, CMS will be issuing further qualifications or standards for orthotic and prosthetic suppliers that these suppliers will need to meet in order to bill for those supplies,” she said.

Bastinelli did not reveal what the NPRM would include, but said CMS would work with those professional groups regarding their services. “You will have the opportunity to comment on the proposed rule,” Bastinelli said, urging one caller to submit comments on who is qualified to fit a brace once the NPRM is published.

While many teleconference callers said the exemptions were great news, Bastinelli reminded others--including home medical equipment providers--of CMS' mandatory accreditation deadline Sept. 30, 2009.

One caller asked if her home health agency was exempt. Bastinelli drove home the point: “If you tried to go into business as a DMEPOS supplier, separate and distinct from your home health agency, yes, you would need to be accredited, and no, you would not be exempt.”

Bastinelli also reminded listeners that as of March 1, 2008, new HME providers must be accredited before submitting their enrollment applications to the National Supplier Clearinghouse.

She suggested that all providers who plan to apply for accreditation should register by Jan. 31, 2009, in order to make sure they get through the process by the Sept. 30 deadline. Otherwise, even though accreditors might accept their applications after that date, “there is no guarantee they will be accredited in time,” she said.

One now-exempt caller, whose company had already submitted the money to an accrediting body to begin the process, wondered how the company would go about getting its money back. Responding to that comment and others from exempt callers who had begun accreditation, Bastinelli suggested they should discuss whether to continue the process with their accreditor. “It's up to you,” she said.

Several callers who fall under the new exemptions stated they had been denied NSC numbers because they were not accredited and asked if they should reapply.

A CMS official responded, “Resubmit the enrollment application. The NSC has been given written guidance on this so there shouldn't be a problem.”

And in response to a question about exemptions for health clinics, CMS issued the following written statement: “DME is not covered within the Medicare Federally Qualified Health Clinic benefit. All FQHCs would need to have a DMEPOS supplier number in order to bill for those separately, and go through the same process as any other DME supplier. Thus, all FQHCs billing for the products covered under the DME quality standards would be subject to the accreditation deadline of Sept. 30, 2009, in order to continue to bill for these supplies.”

Bastinelli said CMS would post a fact sheet and a list of frequently asked questions on the exemptions by today at www.cms.hhs.gov/medicareprovidersupenroll.

A replay of the teleconference will be available Sept. 10 at www.cms.hhs.gov/OpenDoorForums/05_ODF_SpecialODF.asp.