Draft healthcare reform bill does a number on HME

Sunday, July 19, 2009

WASHINGTON - The House Ways and Means and Education and Labor committees on Friday approved a draft healthcare reform bill that they had released earlier in the week. The bill contains a patchwork of HME provisions.

While the bill contains no additional cuts to Medicare oxygen reimbursement, it includes a provision that would require HME providers that service beneficiaries at month 27 to continue to do so for the remainder of the useful lifetime of the equipment (60 months), regardless of the patient's location. Providers can furnish oxygen themselves or make arrangements with another provider.

"One could argue that moving to month 27 will hurt the beneficiary, because providers will no longer have an incentive to provide quality care," said Walt Gorski, vice president of government affairs for AAHomecare. "No one will be willing to pick up that patient if he or she is dissatisfied with their service."

Most likely, the provision was inspired by problems that have arisen as a result of the 36-month cap on oxygen, which kicked off Jan. 1.

"I'm not sure that's going to solve the problem--it just moves it to a different point in time," said Cara Bachenheimer, senior vice president of government relations for Invacare. "Payments should be (tied to) medical need, like any other drug."

 If a provider has declared bankruptcy and if more than 24 months of payments have been made on a patient's current rental period, the provision allows for a new 36-month rental period with a new provider.

The bill also contains provisions on accreditation and surety bonds. Any provider that has submitted an accreditation application before Aug. 1, 2009, shall be deemed as meeting applicable standards and accreditation until the accreditor takes action on the provider's application.

Pharmacies that only provide diabetes testing supplies, canes and crutches would be exempt from accreditation. Further, pharmacies that have had a provider number for at least five years and have never had an adverse action would be exempt from obtaining surety bonds.

"We are pleased that Congress is addressing our concerns," said Bill Popomaronis, vice president of long term and home health care pharmacy services for the National Community Pharmacists Association (NCPA). "Pharmacists already meet burdensome standards through licensing standards that are designed to protect beneficiaries and limit fraud."

Finally, the bill includes a provision that would eliminate the first-month purchase option for Group 1 and Group 2 power wheelchairs. It exempts Group 3 complex power wheelchairs.

Key leaders in the House have a misconception that a large number of Medicare beneficiaries with wheelchairs have short-term needs, said Seth Johnson, vice president of government affairs for Pride Mobility.

"There is some talk about an alternative provision," said Seth Johnson, vice president of government affairs for Pride Mobility. "Nothing has been offered yet, but it would preserve the purchase option (and) meet the goals of the committees."

The Senate Finance Committee's draft healthcare reform bill, which industry stakeholders expect to be released some time this week, so far doesn't contain the provision, said Johnson.

"The Senate has heard quite a bit from consumer and clinician groups in support of preserving the option," he said. "That appears to be resonating well."