Final supplier standards need 'further clarification'

Wednesday, September 1, 2010

BALTIMORE - Some of the new and modified supplier standards that CMS released last week provide more questions than answers, say industry stakeholders.

"While some of these standards are very clear and understandable, others need further clarification," said consultant Mary Ellen Conway, president of Capital Healthcare Group in Bethesda, Md.

One of the standards that needs further clarification: In states where licensure is required for respiratory therapy or other services, HMEs cannot contract for those services; they must be provided by a full or part-time employee. That could have serious implications for some small providers, Conway said.

"If you're a DME company that has one RT and the RT goes on vacation and you hire one from a staffing company, that person is an employee of the staffing company (not the DME)," she said. "They don't do that in other healthcare sectors like nursing homes. What's the expectation here?"

The standards, which go into effect Sept. 27, also expand the prohibition on unsolicited contact with Medicare beneficiaries. In addition to a ban on telephone contacts, providers may not make in-person contacts or use e-mail, instant messaging or "Internet coercive advertising."

"They want to really smack down on the ability to reach out to potential patients who have not expressly asked for contact," said attorney Neil Caesar, president of the Health Law Center in Greenville, S.C. "They have clearly tapped into concerns about solicitation."

Other provisions in the final rule addressed the DME provider's physical space. The site must measure at least 200 feet square; be in a public, accessible location and not in a gated community or other restricted area; be accessible and staffed during posted hours of operation; maintain a permanent and visible sign in plain view; and have space for storing business records.

"We all understand fraud and trying to get rid of it, but I think there are some interesting nuances to these," Conway said. "For example, what does 'plain view' mean for signage? In view of the parking lot? The front door? If they are located upstairs and have a sign on their door, (that may be all they can do). If they are not the landlord of their building, they may not have (other options)."

Conway would also like to see CMS clarify what recourse a provider would have if they were unable to meet certain requirements.

"The last thing somebody needs is to have their number pulled because they can't comply with something out of their control," she said.