AAH: We want clarification on the DRA

Sunday, April 23, 2006

WASHINGTON - AAHomecare sent a letter to CMS Thursday requesting that the agency explain how it intends to implement the 36-month cap on Medicare oxygen reimbursement and eliminate the cap rental option for DME.

Both measures are part of a Deficit Reduction Act that Congress passed and the president signed earlier this year.

"AAHomecare understands that these new payment methodologies do not take effect immediately," the letter states. "However, their impact on our members' operations is immediate because they must begin to structure their operations to respond to the changes. Moreover, providers must plan now for their implementation in order to ensure a smooth transition for Medicare beneficiaries."

The association's letter, addressed to Herb Kuhn, director of the Center for Medicare Management, included 33 questions that the association hopes to have answered during a future meeting with CMS. They include:

- How will CMS define oxygen after the 36-month period of continuous use ends? How will medical necessity documentation for oxygen change? Will lifetime CMNs be valid for beneficiaries who own their own equipment?

- Will the beneficiary be responsible to pay charges for pick up and delivery of oxygen refills after the title to oxygen equipment transfers to the beneficiary? If not, what data does CMS propose to use to arrive at an appropriate payment amount for pick up and delivery?

- Will the Medicare program pay for emergency service calls for beneficiary-owned equipment that is still under warranty? If not, can providers contract with beneficiaries to provide on-call services for patient owned equipment?

- How will providers document that the maintenance and service they performed on oxygen equipment were reasonable and necessary? Will CMS require different documentation depending on whether the provider repairs the equipment it furnished or equipment furnished by another provider?

- Will the requirements of the DRA apply retroactively to Jan. 1, 2006, regardless of whether the need for systems changes result in administrative delays in implementation?