Competitive Bidding Just Tip of the Iceberg for HME

Atlanta While DMEPOS competitive bidding has garnered the industry's most recent headlines, a slew of other changes has emerged for home medical equipment providers that may have gotten lost in the chaotic competitive bidding shuffle.

Industry stakeholders marshalled all their muscle this year to halt the Medicare bidding program that, in fact, went into effect July 1. It was finally rescinded July 15 when Congress overrode the president's veto of H.R. 6331 — which includes a delay of the program — and the measure became law.

Competitive bidding, however, is just the tip of the iceberg. Since the beginning of the year, CMS and its contractors have issued several proposals and directives that will change the way providers do business. To help keep track, here's a roundup that includes some of them.

• Supplier Standards: For years, providers had asked for further guidance and clarification of what many called vaguely written supplier standards. In January, CMS responded, publishing an 11-page draft rule in the Federal Register clarifying and expanding existing supplier standards and adding others that all HME providers must meet to participate in Medicare and retain billing privileges. Comments on the proposed standards were taken until March 25. At press time, a final rule had not been released.

  Among the proposed rule's changes to existing standards:

  • A change to Standard No. 1, which deals with state and federal licensure and regulatory requirements, would require that suppliers providing licensed services not contract out those services. In other words, personnel furnishing licensed services (in states that require licensing of any aspect of a provider's business) must be W-2 employees, not 1099 independent contractors.

  • CMS would expand existing Standard No. 7 regarding physical facilities and appropriate sites. The agency proposed that hours of operation be posted on permanent signage at the main entrance to the supplier location, even if the business is in a building complex where it is not the only tenant.

    In addition, the location must be staffed during posted hours and must be accessible “regardless of whether beneficiaries routinely visit the facility,” according to the proposal. The requirement also would apply to “closed door” businesses, such as pharmacies or suppliers providing services only to beneficiaries in a nursing home. “A supplier is not in compliance with this standard if no one is available during the posted hours of operation,” CMS said.