Fighting home care battles in Washington can be like playing a game of chess: You have to look at the whole board and pay attention to each piece. Your success depends on how well you can picture a series of moves, analyze them and appropriately respond to them.
Legislative issues like the recent budget battle involving capped rental may command a lot of attention due to their visibility in Washington. But for every legislative issue that comes up, there are typically many more regulatory issues in play that demand pre-emptive or corrective moves.
Members of AAHomecare's Regulatory Committee, in their first meeting of 2006 in February, identified a number of home care issues in the regulatory pipeline that require action. Among the topics under discussion were the following:
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National Competitive Bidding (a.k.a. “restrictive contracting”): On the legislative front, providers should continue to urge their members of Congress to sign on to the Hobson-Tanner bill (H.R. 3559), which includes patient access and small business protections.
At the same time, on the regulatory front, we need to advocate for appropriate rules from CMS and monitor the status of quality standards for providers as the home care community waits for the release of the notice of proposed rulemaking for competitive bidding. We expect CMS to issue the NPRM sometime this spring. Once it is released, AAHomecare and other stakeholders will provide comments to CMS, urging them not to rush implementation in order to ensure they “get it right.”
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Oxygen and HME Capped Rental: Home care providers must continue to express concerns and pose questions to CMS and Congress about the capped rental changes. This can complement grassroots efforts on Capitol Hill to repeal the 36-month cap on oxygen and the 13-month cap on capped rental HME items passed in the Deficit Reduction Act. It will also be important to be engaged with CMS in crafting HCPCS codes and descriptions for maintenance, repair and other services providers typically provide during the rental period so that, if the cap is implemented, these crucial services can continue to be performed and reimbursed.
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Rehab and Assistive Technology: April marks the first month of implementation of the interim final rule for power mobility equipment, and it will be critical for the home care community to continue efforts to ensure the power mobility codes and local coverage determination preserve patient access to the most medically appropriate equipment, services and technology. We should also ensure that the final rule for PMD provides for greater documentation clarity, physician education and a 60-day timeframe for the face-to-face exam.
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Pay-for-Performance: As Washington continues its push toward pay-for-performance and outcomes measures, it will be important to look at ways for HME companies to become involved in quality initiatives as well as to assess process and outcomes measures.
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Other Key Issues: Participating in comment periods and monitoring issues related to the National Supplier Clearinghouse National Provider Identifier number are ongoing matters that require attention, along with the Durable Medical Equipment Regional Contractor transition to the new DME “Medicare Administrative Contractors,” or DME MACs.
Finally, through AAHomecare's Medical Gases Committee, the home care community has worked with the FDA for the past few years on the Current Good Manufacturing Practices initiative for medical gases to ensure it is as fair and favorable to the industry as possible. This regulatory guidance from FDA is expected to be released sometime this year.
It's always important to keep an eye on Congress. But as we have seen with quality standards, inhalation drug therapy fees and many other issues, the regulatory process at CMS and other agencies also plays a huge role in how home care policy is rolled out. Keeping an eye on the CMS Web site and others for home care stakeholder organizations such as AAHomecare is a good way to keep informed — and involved.
Tom Ryan is chairman of the board of directors of the American Association for Homecare, Alexandria, Va., and CEO of Homecare Concepts in Farmingdale, N.Y. For more information about AAHomecare, call 703/836-6263 or visit www.aahomecare.org.
