Oxygen cap: Industry lobbies; providers appeal; CMS releases more details

Sunday, November 23, 2008

WASHINGTON - Even as the HME industry made an 11th-hour push to repeal the 36-month oxygen cap last week, stakeholders admitted their chances of succeeding this year appear slim.

"We can't be faulted for trying," said Wayne Stanfield, executive director of the National Association of Independent Medical Equipment Suppliers (NAIMES). "We are still continuing with the calls."

NAIMES seeks to have language that repeals the oxygen cap attached to any bill that makes it to the floor in the remaining few days of 2008, including a possible bill to bail out of the ailing auto industry.

Industry stakeholders encouraged providers to reach out to members of Congress while they're in their home districts this week and urge them to repeal the oxygen cap this year or make it a priority next year.

"Make them aware of what the oxygen cap means now and in the future," said John Gallagher, vice president of government relations for The VGM Group. "Congress is going to push real hard in the first 100 days of the new administration to get healthcare reform."

Sen. Max Baucus, D-Mont., and Rep. Pete Stark, D-Calif., have indicated they would like to exclude healthcare reform from pay-go rules, so the industry needs to strike while the iron is hot, Gallagher said.

"Let's get language to get rid of the cap and competitive bidding in there," he said.

Providers appeal to SBA
By Theresa Flaherty Managing Editor
MIAMI - Members of the Accredited Medical Equipment Providers Association (AMEPA) filed complaints last week with the Small Business Administration that charge CMS with failing to consider the oxygen cap's impact on small businesses.

"This is what the SBA is for," said Rob Brant, president of the association. "Hopefully they will see that this is going to hurt and bankrupt a lot of small oxygen providers."

The complaints state that CMS did not comply with the Regulatory Flexibility Act, which requires government agencies to analyze the impact of regulations on small businesses. Using the SBA's definition, about 85% of DME providers are considered small businesses.

Beginning Jan. 1, providers must continue providing supplies, repairs and emergency services to capped oxygen patients, but they can no longer bill Medicare for them. They can still bill for contents and, twice a year, for routine service and maintenance.

Small businesses can't afford to maintain the current level of services to capped oxygen patients without reimbursement, Brant said.

In recently released guidance on the oxygen cap, however, CMS states that any impact on small businesses is "positive rather than negative," because providers retain ownership of equipment.

"Getting a piece of 3-year-old equipment back does not make up for the costs we are going to incur," Brant said. "The cost is in the 24/7 service that we provide. We have to make the SBA aware this is not a positive."

CMS releases more details
BALTIMORE - CMS last week released a Medicare Learning Network (MLN) Matters article with additional details on the 36-month oxygen cap. To read the article, go here: http://www.hmenews.com/downloads/MLN_Matters_oxygen.pdf