Proposed Florida law would require HME accreditation

Monday, February 28, 2005

TALLAHASSEE, Fla. - Florida providers can expect more changes to the state’s Medicaid program, though this time competitive bidding is not in the picture.

House Bill 179, which was introduced in January, if passed would require the state’s HME providers to become accredited in order to obtain state licensure.

Proponents of the bill, including a group of pediatric DME providers and the Florida Association of Medical Equipment Services (FAMES), call it an “anti-fraud bill” that looks to diminish the prevalence of fraud and abuse in the state.

“I think providers have two choices: Either they self regulate or they will get regulated any ways,” said Javier Talamo, vice president of FAMES and the attorney who drafted the bill. “I don’t think everyone is going to be happy with the bill, but I think they are going to be less unhappy with something that is drafted by the DME industry rather than something that was drafted by the legislature.”

The bill includes several provisions, including mandatory accreditation. If the bill passes, starting Jan. 1, 2006, providers seeking to obtain or renew their state HME license would need to submit proof of accreditation from JCAHO, CHAP, ACHC or another national accreditation agency approved by the state.

The bill’s language creates a definition for “high-tech medical equipment provider” and mandates higher standards for those businesses in terms of staffing and inventory. It also closes a loophole that allows businesses with an oxygen license to forgo the inspections necessary to get an HME license.

Discussions are still ongoing as to the required business hours for a licensed HME included in the bill, according to Talamo.

Talamo said the intent of this bill is to identify Medicaid’s abusers, thereby reducing the overall cost of the program. Florida estimates that 10% of its Medicaid costs stem from fraud.

The state is looking to cut 20% from its HME expenditures through competitive bidding or a cut in the fee schedule, yet Talamo said the cuts could be less drastic if fraud is reduced first.

“Whenever you have a massive amount of fraud the reaction of the government is to cut everyone,” he said. “Well, before you go cutting everyone, we say lets eliminate the 10% or so that is fraud and let’s see what the DME expense really is. This bill is going to clarify, I believe, what is being spent on DME and what is fraudulent billing.”