DENVER — In an Oct. 30 email, a CMS representative said Medicare beneficiaries in some areas of Montana "may experience supplier access issues in obtaining certain DMEPOS."
A CMS staff member from the agency's Division for Medicare Health Plans Operations, Region VIII, noted in the Friday afternoon message that "potential access issues" with oxygen, enteral nutrition, parenteral nutrition and power wheelchairs could affect beneficiaries' access for the following equipment and supplies in eight Montana counties:
- Oxygen — Daniels, Sheridan, Roosevelt, Phillips, Musselshell and Fegrus
- Enteral Nutrition — Stillwater and Carbon
- Parenteral Nutrition — Roosevelt, Stillwater and Carbon
- Power Wheelchairs — Sheridan, Stillwater and Carbon
"Keep in mind this information is subject to change because supplier accreditation is ongoing," read the email, suggesting that the access issues are related to the agency's recently implemented surety bond and accreditation requirements.
In addition, the email said, "If a beneficiary's supplier doesn't meet these new requirements, the beneficiary will have to look for another Medicare-approved supplier in order for Medicare to pay for their equipment and supplies. If a beneficiary continues to get supplies from a supplier who has not met these requirements, Medicare won't pay and the beneficiary may have to pay the full cost for the supplies … Although most suppliers will continue in the Medicare program, some have chosen not to stay enrolled."
The message advised that "beneficiaries should ask if their current supplier plans to meet these new Medicare program requirements to avoid any interruption in their services."
While the email was sent to an unspecified list including some home medical equipment providers, CMS has apparently been sending beneficiaries across the country the same message.
According to Rose Schafhauser, executive director of the Midwest Association for Medical Equipment Services, customers of some MAMES members have been receiving letters telling them that if their medical equipment supplier "hasn't yet met the new requirements to become Medicare-approved, starting October 1, 2009, the supplier can no longer bill Medicare for your medical equipment or supplies."
Signed by CMS Acting Administrator Charlene Frizzera, the letter reads:
"These new Medicare program requirements for suppliers were created under the law and are intended to protect you and Medicare from fraud. They also ensure that by using a Medicare-approved supplier, you can have peace of mind that you are getting high-quality products and services. As always, you may continue to use your current supplier. However, if they don't meet the new requirements, you may need to pay the full cost for your supplies."
"CMS did not list the company name on the letter," Schafhauser noted in MAMES' Monday newsletter, "but this didn't seem to matter for customers [who] have been calling the home medical equipment companies extremely upset. In addition, we are hearing reports throughout the country that beneficiaries are receiving these letters — so it seems that CMS has released these letters across the country."
"My real problem with all of this is from the patient perspective," said Wayne Stanfield, president of the National Association of Medical Equipment Suppliers. "CMS is putting the burden on the frailest, sickest people in the Medicare system who rely on home care to ensure their quality of life. Now all of a sudden they are put in the position of having to police the care they are getting, and Medicare is telling them Medicare won't pay their bills. That's got to be causing significant stress for a lot of patients."
Because the CMS email on potential Montana problems "came from the Part A side," Stanfield said, "my guess is that the issues related to access came to light because physicians or hospitals were unable to find providers in those counties that were able or willing to serve patients.
"If this is happening in Montana, this is happening in 15 or 20 other predominantly rural states right now," Stanfield said. "The truth is it's also going to hit any states that have large spaces between towns."
Instead of helping Medicare beneficiaries continue to get high-quality products and services and prevent fraud, he said, the accreditation and surety bond requirements could cause interruption in patient care.
"It's clear the $50,000 surety bond mandate per store combined with up to $25,000 accreditation cost is a financial burden too great for many small independent suppliers to shoulder," Stanfield said.
"The email talks about how the two programs that have created these access issues were designed to eliminate fraud and abuse while still assuring quality products are provided, but no matter how you look at it, these programs are eliminating suppliers, and they are eliminating small, independent suppliers who … may be the only supplier in small-town, rural America."
Competitive bidding will only worsen the situation, he continued.
"Everything is impacting the patient," Stanfield said. "The unfortunate thing is that in [CMS'] zeal to curb fraud and abuse and to limit suppliers, they are harming the people who need the services."
