CMS Issues Final Rule on Supplier Standards

BALTIMORE — The Centers for Medicare and Medicaid Services issued a final rule today on Medicare enrollment standards for DMEPOS providers.

Based on a proposed rule issued in 2008, the new regulation adds several new standards and modifies existing standards that providers must meet before being able to furnish home medical equipment to Medicare beneficiaries. According to a statement from CMS, "These new and stronger standards will help to reduce fraud in Medicare and provide beneficiaries with additional assurance that they are being served by legitimate suppliers who meet Medicare's standards."

"We know the majority of medical equipment suppliers and health care providers want to improve the health of Medicare beneficiaries, but we also know there are those who look for any opportunity to take advantage of beneficiaries and Medicare, including sham operations who are not legitimate businesses," said Peter Budetti, CMS deputy administrator for program integrity, in the statement. "The steps we are taking today provide us with additional tools to support our continuing efforts to reduce Medicare fraud by helping to ensure that only appropriately qualified suppliers are enrolled in the program."

According to CMS, the final rule will:

• Require HME providers to obtain oxygen from a state-licensed oxygen supplier (which applies only in states that require oxygen licensure).

• Require HME providers to remain open to the public for at least 30 hours per week, with exceptions for physicians or licensed non-physician practitioners furnishing services to their own patients as part of their professional service, and HME providers working with custom made orthotics and prosthetics.

• Ensure that HME providers continue to maintain ordering and referring documentation from physicians or non-physician practitioners.

• Prohibit HME providers from sharing a practice location with certain other Medicare providers and suppliers subject to certain exceptions.

The final rule also clarifies and expands the existing enrollment requirements that DMEPOS providers must meet to establish and maintain billing privileges in the Medicare program. Specifically, this final rule would revise current standards as follows:

• Ensure that the DMEPOS supplier maintains a physical facility on an appropriate site that must: