Disaster relief: Stakeholders press for policy changes

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Friday, September 8, 2017

WASHINGTON – As Hurricane Irma barreled toward Florida last week, industry stakeholders met with CMS officials to discuss serious issues that arise in disaster situations.

One thing being discussed: Whether there is a possibility of getting the Federal Emergency Management Agency to pay for oxygen tanks in such situations, says Tom Ryan, president and CEO of AAHomecare.

“If CMS indicates (there could be) a gap in coverage—and Laurence Wilson seems willing to do that—it’ll notify FEMA,” he said. “I am also reaching out to FEMA. We have to quickly determine how we can get a funding stream and get ourselves teed up.”

CMS on Thursday did provide some relief in the wake of Hurricane Harvey, issuing guidance stating that it will pay for beneficiary-owned DME that has been damaged or destroyed in circumstances related to a declared emergency.

Stakeholders say that storm, which made landfall on the Texas Gulf Coast on Aug. 25, made it quickly apparent that Medicare rules limiting the provision of HME to only contract suppliers in competitive bidding areas like Houston, and the inability to get replacement tanks paid for, are shortsighted.

“There is a possibility that there are going to be access issues, that the contracted suppliers will not be able to handle the increased capacity during this emergent situation,” said Ryan.

Stakeholders say it’s also time to revisit longstanding policy that providers cannot be paid for the back-up tanks they put out in such situations. While in the past, providers absorbed the hit, today’s reimbursement rates make that unfeasible, says Ryan who, as a former provider, speaks from experience.

“I lost tens of thousands of dollars back when Sandy hit,” he said. “But I was at least getting reimbursed at a reasonable amount. I don ‘t know how a provider who is financially restrained today can go out for four to six weeks and deliver oxygen.”

CMS’s guidance last week also extends the notification deadline for subcontracting agreements to 30 days; and waives the requirements for a new physician order, face-to-face visit, and new medical necessity documentation for replacement equipment.

“Basically, suppliers are to put a narrative on the claim when they submit it,” said Kim Brummett, vice president of regulatory affairs for AAHomecare. “One thing we want to be sure of is that they issue very clear guidance on this that those claims aren’t exposed to audits (for these things).”

Stakeholders are also looking ahead to a longer-term fix that ensures beneficiary access to care when disaster strikes.

“We have to find out where they are legally prevented from making changes and determine how we can give them more flexibility,” said Ryan. “We want to follow up and see if we can get some legislative language that might unencumber them a little.”