Oxygen: Reform, sign-on letter, not-so-new CMN

Sunday, March 1, 2009

ARLINGTON, Va. - Stakeholders charged with developing a unified plan to reform the Medicare oxygen benefit are making some progress, they say.

"Slowly but surely," said Alan Landauer, chairman of AAHomecare's board of directors.

 Landauer and eight other stakeholders sit on a subcommittee of the New Oxygen Coalition (NOC) that has held numerous teleconferences recently to discuss reform.

 The biggest stumbling block for those involved has been how to best pay for oxygen. One 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.

 Worried about the administrative and financial burdens such a plan could put on small and independent providers, two state associations have come up with alternatives. They also categorize patients based on ambulation but don't further adjust reimbursement.

 Stakeholders report more "give-and-take" during recent teleconferences.

 Despite differences, "everyone knows that we have to move forward," said John Gallagher, vice president of government relations for The VGM Group and a member of the subcommittee.

Lawmakers put their support in writing

WASHINGTON - A letter signed by 123 representatives has been sent to the leaders of the powerful Ways and Means and Energy and Commerce committees, urging them to ask CMS to pay for home oxygen therapy through a beneficiary's period of medical need. The letter, circulated by Reps. Tom Price, R-Ga., Mike Ross, D-Ark., Heath Shuler, D-N.C., and Jo Ann Emerson, R-Mo., raises awareness of the issues surrounding the cap, such as compromised patient care and increased costs, said John Gallagher, vice president of government relations for The VGM Group. "The leadership needs to know this is an issue that they need to address," he said.

CMN: It's not so new

WASHINGTON - Despite reports to the contrary, the DME MACs for jurisdictions A and B have not issued a new certificate of medical necessity (CMN) for oxygen. "The purpose of the article was not to talk about a new CMN document, but to talk about some of the scenarios that have come up due to the 36-month cap and how they apply in the CMN world," said Dr. Paul Hughes, the medical director for the two jurisdictions. The Feb. 18 article details the four situations in which a new 36-month rental period can begin and for which a new initial CMN is required: 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.