CMS defines durability, industry awaits CBO score

Thursday, November 3, 2011

WASHINGTON - CMS last week issued final rules related to durable medical equipment, including a finalized definition of "durability."

CMS originally proposed the defining "durability" as meeting a three-year minimum lifetime standard in the July 8 Federal Register. At the time, stakeholders said they were unsure of what CMS sought to accomplish.

They're still unsure.

"We're still trying to sort it out," said Jay Witter, senior director of government relations for AAHomecare. "The proposed rule was kind of vague, so our manufacturers didn't understand how it would affect their equipment."

Initial concerns included whether redesigned equipment--saying improving the technology on an existing wheelchair--meant that it would have to meet the new criteria, and what the process for meeting that criteria is.

"It's still not clear what the process is," said Witter, who was still analyzing the rule last week. 

The other rule finalized provisions related to competitive bidding that were included in an interim final rule released in January 2009, and the Medicare Improvements to Patients and Providers Act of 2008.

"They tied up some loose ends, but there was no new policy," said Cara Bachenheimer, senior vice president of government affairs for Invacare. "The more disconcerting thing was that CMS used it as another opportunity to talk about how great Round 1 was."

Meanwhile, the industry continues to build consensus for a market pricing program (MPP) as an alternative to competitive bidding.

"We're trying to get it scored by the Congressional Budget Office," said Tyler Wilson, AAHomecare's president and CEO. "Then we'll know whether we've met the $20 billion in savings, or whether we need to find some additional savings. There's a lot at play and we have limited opportunity for conversations (with lawmakers)."

Concerns have been raised that pushing forward with MPP would mean throwing Round 1 providers under the proverbial bus. While no one wants to see that happen, lawmakers have said they won't support MPP if it includes changes to Round 1.

"It is a political reality that we can't get everything we want," said Wayne Stanfield, executive director of NAIMES. "Sometimes its prudent not to fight for everything, but take what you can get, with hopes of changing the impact on Round 1 afterward."

Sean Schwinghammer, president of the Florida Association of Home Care Suppliers has said he's disappointed that the industry is moving forward without any relief for Round 1, but says he is supportive of MPP.

"We are united in MPP and think it's a good idea for Round 2," he said. "But, to be clear, its ludicrous to use Round 1 as the justification for altering Round 2, and leaving Round 1 to exists."



I don't know the exact purpose of defining the term "durable" but knowing CMS I am sure that somehow this will result in them paying providers less than before. It seems to be a reoccuring theme with these guys.