Oxygen: Reform efforts continue, letter circulates, CMS issues CMN details

Sunday, February 22, 2009

ALEXANDRIA, Va. - Members of a new subcommittee dialed into a teleconference late on Friday to take another crack at creating a unified plan to reform the Medicare oxygen benefit.

AAHomecare formed the subcommittee after members of its New Oxygen Coalition (NOC) failed to come to a consensus during a face-to-face meeting Feb. 11, according to sources.

"They think that a smaller group will work more efficiently to come up with a unified plan," said Rose Schafhauser, a member of the NOC and chairwoman of AAHomecare's State Leaders Council. "Then the group will present a plan to NOC as a whole."

The nine-member subcommittee: AAHomecare's Alan Landauer, Apria's Lisa Getson, Pacific Pulmonary's Chris Kane, Invacare's Joe Lewarski, The VGM Group's John Gallagher, The MED Group's Don Clayback, NAIMES's Wayne Stanfield and providers Mike Calcaterra and Jason Rogers.

So far, the biggest stumbling block for NOC members has been how to best pay for oxygen. The main proposal, crafted by the Council for Quality Respiratory Care (CQRC), entails putting patients into different reimbursement buckets based on ambulation and then adjusting that reimbursement based on factors like liter flow.

Several members, mostly small and independent providers and the groups that represent them, dislike the CQRC's proposal. They say it's administratively burdensome.

"It doesn't favor small and independent providers," said Wayne Stanfield, executive director of NAIMES.

Calcaterra, Montana chairman for the Big Sky Association of Medical Equipment Suppliers, and Rogers, president of the Georgia Association of Medical equipment Services (GAMES), have come up with alternative proposals that also categorize patients based on ambulation but don't further adjust reimbursement.

Ahead of Friday's meeting, members of the subcommittee were given additional details on the CQRC's proposal. Opponents of the proposal have complained that the CQRC has played things too close to the vest, keeping them in the dark on reimbursement rates and other details.

Dozens of legislators decry oxygen cap

WASHINGTON - More than three dozen members of the U.S. House of Representatives have signed a letter that recommends CMS pay for home oxygen therapy throughout a beneficiary's period of medical need. The letter was written by Reps. Tom Price, R-Ga.; Heath Shuler, D-N.C.; and Jo Ann Emerson, R-Mo. To view the sign-on letter, go to www.aahomecare.org.

DME MACs issue CMN details

WASHINGTON - The DME MACs for Jurisdictions A and B shared details last week on certificates of medical necessity (CMNs) for oxygen. The CMN includes the "four general situations in which a new 36-month rental period is begun": initiating use of home oxygen; resuming use after a break in medical necessity of at least 60 days; replacing equipment after a patient reaches the five year reasonable useful lifetime; and replacing equipment due to damage, theft or loss. AAHomecare has posted the announcement on its Web site: http://www.aahomecare.org/associations/3208/files/Oxygen-CertificatesOfMedical%20Necessity-ReplacementEquipment.pdf.