In 2004, plenty of work remains to be done. Congressional members are scheduled to come back in mid-November, and there is a long list of regulatory issues that continue to demand constant attention.
But so far this year, the American Association for Homecare and the entire home care community — our councils and committees, providers, state associations, manufacturers and all stakeholders — have made great strides toward achieving key goals.
Cuts to DME Reimbursement
One of AAHomecare's top goals is to repeal or mitigate the Medicare reimbursement cuts for certain DME items (oxygen, nebulizers, hospital beds, air mattresses, wheelchairs, lancets and glucose test strips) required by the Medicare Modernization Act (MMA).
Immediately after MMA was signed into law in December 2003, AAHomecare and its members began to work with the HHS Office of Inspector General (OIG) on the oxygen reimbursement issue. We have worked long and hard all year to educate Congress, the OIG and the Centers for Medicare and Medicaid Services about the negative effects of all of these DME cuts on home care providers and Medicare patients. We are still working closely with CMS providing data, and with the OIG on oxygen reimbursement.
During the association's Washington Legislative Conference in June, Reps. David Hobson, R-Ohio, and Harold Ford, Jr., D-Tenn., introduced H.R. 4491, which would repeal the reduction in Medicare payment for these items. Since then, through grassroots efforts by members and state associations as well as inside-the-Beltway lobbying activity, 104 cosponsors have signed on to the bill. This level of support gives the home care community credibility and momentum in Washington.
Congress, the White House and the regulatory agencies know that the home care community will stand up on issues that matter to providers and to the Medicare patients they serve. Everyone must continue to urge members of Congress to sign on as cosponsors until Congress adjourns.
Remember to thank those members who are cosponsors. They are our home care champions!
Reimbursement for Inhalation Therapies
Another goal is to address the reimbursement formula for inhalation drugs and work to add a service fee. AAHomecare has been working with the Government Accountability Office (GAO) and CMS on this issue all year.
The association commissioned Muse and Associates to conduct a study, published in August, to determine the operational and administrative costs of delivering inhalation therapies to Medicare patients. The study found a $68 gap, per monthly supply, between Medicare reimbursement and the costs of delivering inhalation therapies to Medicare patients. In comments and meetings, we shared this information with both CMS and the GAO.
In October, the GAO published a report (Appropriate Dispensing Fee Needed for Suppliers of Inhalation Therapy Drugs) that included this statement from CMS Administrator Mark McClellan: “After reviewing the comments and the information from the GAO survey and other public sources, we believe that $55.00 to $64.00 per month is a reasonable range for a 2005 fee.”
We hope this will be reflected in the final rule issued by CMS. It would be an extremely welcome development for Medicare patients who deserve continued access to these critical therapies and for the providers who serve these patients.
AAHomecare and its members continue to rise to the task of tackling the issues of critical importance to the industry. The home care community must continue to lead the fight before Congress and the administration to ensure public policies that protect and promote the home care industry. And we must be prepared to respond to all opportunities and threats as they arise.
Thanks and kudos again to all of the providers, AAHomecare councils and committees, state associations and manufacturers who have done so much to achieve great progress for the home care community.
Kay Cox is president and CEO of the American Association for Homecare, Alexandria, Va. For more information about AAHomecare, visit www.aahomecare.org, or call 703/836-6263.
