At press time, the Senate Finance Committee was proceeding through its markup of the proposed health reform package. While the House has already passed a health care reform bill, all eyes are on the Senate, because many believe that a health reform package that can pass the Senate is what will ultimately become law.
In the committee's “Chairman's Mark,” there are several provisions that relate to DME. While there are opportunities for changes to the package, the provisions relating to DME are not likely to change significantly.
Notably, at press time there was no provision relating to Medicare home oxygen payment or policy, though it remained a distinct possibility that the oxygen provision would resurface soon. For that reason, this draft provision is also described below.
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Expansion of Round 2 of the Competitive Bid Program: This provision would increase Round 2 of the bid program by 21 additional MSAs and would require the HHS Secretary to bid all areas of the country OR apply bid rates nationwide by 2016. All other provisions in current law pertaining to the bid program would remain in place, such as the Secretary‘s discretion to exempt rural areas and areas with low population density within a MSA.
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Elimination of First Month Purchase Option for Standard Power Wheelchairs: This provision would eliminate the first month purchase option for power wheelchairs, but retain the option for complex rehab power wheelchairs (defined as Group 3 and above).
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Accreditation Exemption for Certain Pharmacies: This provision would exempt certain pharmacies with a small percentage of Medicare DMEPOS billings from the accreditation requirement. The provision would also allow the Secretary to determine accreditation standards that are more appropriate for pharmacies.
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Elimination of 2 Percent Increase in Payment for DME in 2014: The provision would eliminate the 2 percent add-on payment in 2014 that Congress provided for in last year's Medicare Improvements for Patients and Providers Act (MIPPA).
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Proposed Draft Oxygen Payment Provision: While not in the package at press time, there was still considerable discussion about this provision possibly being inserted at a later date. The provision would change the payment levels depending upon the type of equipment provided: 1) stationary only; 2) stationary plus portable; or 3) stationary plus new technology or OGPE. The provision would eliminate the 36-month cap, and payment would continue for the duration of medical need.
Beneficiaries with nocturnal only or stationary only oxygen needs would be paid at about $80 per month; beneficiaries who are on stationary plus portable (tanks that are delivered) would get approximately $185 per month; and beneficiaries who are on stationary plus new technology (OGPE defined as portable oxygen concentrators or transfill units) would be paid at current level of approximately $227 per month. There has been discussion that certain services would be included in the statute to reflect the service component typically provided.
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Anti-fraud and Abuse: The Mark contains a number of anti-fraud provisions related to HME providers, including provider screening, enrollment application fees; enrollment disclosure requirements; and surety bonds. In addition, as a condition of payment, physicians must have a face-to-face encounter with the patient before making a referral for home health or DME.
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Payment: The maximum period for submission of Medicare claims would be reduced from 36 months to not more than 12 months.
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Overpayments: The 60 days providers and suppliers have to repay Medicare overpayments would be modified to either 60 days after the date on which the overpayment was made or the date the corresponding cost report is due. Providers would be required to repay any Medicare or Medicaid overpayment identified through an internal compliance audit.
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A specialist in health care legislation, regulations and government relations, Cara C. Bachenheimer is vice president, government relations, for Invacare Corp., Elyria, Ohio. Bachenheimer previously worked at the law firm of Epstein, Becker & Green in Washington, D.C., and at the American Association for Homecare and the Health Industry Distributors Association. You can reach her at 440/329-6226 or cbachenheimer@invacare.com.
