Prescription for Change

It's been a few weeks since Dec. 8, when President Bush signed the Medicare Prescription Drug, Improvement, and Modernization Act of 2003 into law. With regard to its impact on the home medical equipment industry, this is, without a doubt, the most devastating package of legislation ever passed by Congress.

The following summary details some of the many HME-related provisions in the new law and explains the potential impact of those provisions on individual providers and the industry as a whole.

Mandatory Accreditation

The U.S. Dept. of Health and Human Services will establish and implement “quality standards” to be applied by independent accreditation organizations. Durable medical equipment suppliers must comply with these standards in order to furnish DME to Medicare beneficiaries and to receive and retain their Medicare supplier numbers.

These quality standards will apply to DME, orthotics and prosthetics, medical supplies and parenteral and enteral nutrition (PEN). Within one year of the date the quality standards are implemented, HHS will designate one or more independent accrediting organizations.

Since there is no effective date, this provision is likely to be a “back-burner” issue for CMS, given the agency's overwhelming workload to implement the many prescription drug provisions.

Face-to-Face Examination

HHS will specify certain items that require a face-to-face examination of a Medicare beneficiary by a physician, or other qualified prescriber, and a prescription before a supplier can submit a claim to Medicare.

Power wheelchairs will be added to the list of items requiring a prescription prior to delivery. Further, upon medical review, the durable medical equipment regional carriers will be looking at the patient's medical record for evidence that an in-person examination was performed by a physician, and that those medical records reflect the need for and prescription of a power wheelchair.

This provision was effective on Dec. 8, 2003, the date of enactment. (See the “Headline News” section in this issue for more.) It is unclear how CMS will define what constitutes a “face-to-face” examination and the timeframe within which an examination must be performed prior to the physician completing the certificate of medical necessity.

HHS is required to apply these same standards to items for which the department determines there has been a proliferation of use, consistent findings of charges for items not delivered or consistent findings of falsification of documentation.