Permanent exemption for pharmacies?

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10/23/2009

A provider emailed me the other day wondering if the deadline extension for pharmacies to get accredited would include big-box stores like Walgreens.

I couldn't provide him with a detailed answer, except to say I didn't think so (hey, this stuff confuses me, too).

I do know that part of the reason for the extension was also to buy more time to get a permanent exemption from the requirement in there.

This morning, in poring over VGM's analysis on the latest version of the Senate Finance Committee's health care bill (thank you VGM!)  I came across the provision to permanently exempt "certain" pharmacies from accreditation. Here it is:

Effective January 1, 2010, the Committee Bill would make certain pharmacies eligible for an exemption from the accreditation requirements.  A pharmacy would be exempt from the accreditation requirements under the following circumstances: (1) the pharmacy submits an attestation that its total Medicare DMEPOS billings are, and continue to be, less than a rolling three year average of five percent of total pharmacy sales; (2) the pharmacy submits an attestation that it is enrolled as a provider of durable medical equipment, prosthetics, orthotics, and supplies under the Medicare program for at least 5 years and has had no adverse determination against it for the last five years due to fraud; and (3) the pharmacy is willing to submit documentation to the Secretary (based on a random sample of pharmacies) that would allow the Secretary to verify the information in (1) and (2).  The documentation submitted for (3) would be required to consist of an accountant certification or filing of tax returns by the pharmacy.

The provision would also allow the Secretary to determine accreditation standards that are more appropriate for pharmacies. The Secretary would have the authority to implement this amendment by program instruction or otherwise.

Theresa Flaherty

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Comments

While doing some research the other day (to determine if a competitor had managed to slip in under the accreditation wire), I was surprised to discover that all WalMart stores (and some Sam's Clubs) have been accredited by ACHC. What are the odds that they went through the same type of survey as we have? Are they bound by the same regulations as we are (mandatory submission of claims, providing supplier standards to all Medicare beneficiaries, following CMS complaint resolution procedures, having ABNs for items likely to be denied, offering rental option on inexpensive equipment, provide delivery, etc., etc. etc.)?