2006 Legislative Impact on Home Care Joan Kohorst, MA, RRT Apria Healthcare AARC Home Care Section...

2006 Legislative Impact on Home Care

Joan Kohorst, MA, RRT

Apria Healthcare

AARC Home Care Section Chair

2006

Inhalation drugs Competitive bidding Quality standards Mandatory accreditation 36 month oxygen CTS OIG Advisory Opinion # 06-20

Inhalation Drug Therapy Coverage

Medicare Part B Coverage Covers inhalation drugs administered via a nebulizer under

the DME benefit

CMS has decreased reimbursement for inhalation drugs three times in the last two years

CMS added a dispensing fee in 2005 and decreased the dispensing fee by 50% in 2006


CMS studied need for dispensing fee and found that the dispensing fee covered shipping/handling, pharmacy activities and services Patient education Compliance monitoring / refill calls Caregiver training Care coordination In home visits


CMS does not believe Congress intended that Medicare pay for pharmacy care management services as part of dispensing fee

Hence the 50% decrease in dispensing fee in 2006

Metered Dose Inhalers

MDIs are covered under Part D AARC strongly recommended that CMS

recognize the importance of education and training in effective use of MDIs/DPIs Qualified / credentialed health

professionals Separate payment to physicians

Metered Dose Inhalers

CMS already provides payment for beneficiary training by a physician or physician’s staff

DME fee includes, in part, amounts for training beneficiaries on use of nebulizer equipment

Local Coverage Determination for Nebulizers

Levalbuterol DuoNeb Amikacin, atropine, beclomethasone,

betamethasone, bitolerol, dexamethasone, flunisolide, formoterol, gentamicin, glycopyrrolate, terbutaline & triamcinalone

Competitive Bidding

MMA requires Medicare to replace the current DME payment method with competitive bidding process Durable Medical Equipment Enteral Nutrition Orthotics and Prosthetics

Objectives of Competitive Bidding

Reduce Medicare expenditures Determine appropriate prices for

categories of DME Protect beneficiary access Reduce beneficiaries’ out of pocket Reduce proliferation of certain DME

items

Phased-In Implementation

10 of largest MSAs in 2007 (probably October)

80 of the largest MSAs in 2009 Additional areas after that May be phased in first among highest

cost and highest volume items and services

Status on Competitive Bidding

Final rules for accreditation of DME providers for competitive bidding program were released by CMS on August 1, 2006

www.cms.hhs.gov/competitiveacqforDMEPOS

Quality Standards for DME Providers

MMA requires DME providers to comply with standards

Final version of the Quality Standards were released August 2006

www.cms.hhs.gov/CompetitiveAcqforDMEPOS/04

_New_Quality_Standards


Appendix A: Respiratory Equipment, Supplies and Services defines respiratory services as encompassing the provision of home medical equipment and supplies that require technical and professional services


Appendix A goes on to require that “the supplier shall comply with the current American Association for Respiratory Care Practice Guidelines” on oxygen therapy in the home,

long term invasive mechanical ventilation in the home, and intermittent positive pressure breathing


Appendix A further requires that “suppliers shall provide training to beneficiaries consistent with the current AARC CPGs” on long term invasive mechanical

ventilation in the home, O2 therapy in the home, IPPB, suctioning of the pt in the home and and providing patient and caregiver training


The AARC asked volunteers from the Home Care Section to take on the task of revising these five CPGs

We made our recommendations consistent with best practices and standards of care


Our revisions were submitted to the AARC for approval on 09/29/06

Draft guidelines are making their way through the CPG Committee’s final review process now

DME Accreditors

All DME providers who plan to participate in the competitive bidding process must be accredited by an independent accrediting entity

CMS recommends obtaining accreditation by early 2007 accrediting providers in MSA areas first

Deemed Accreditors

JCAHO CHAP HQAA NBAOS BCP

www.cms.hhs.gov/competitiveacqforDMEPOS

ACHC BO/PC NABoP CARF ABCOP The Compliance Team

Legislative Changes / Oxygen

The Deficit Reduction Act (DRA), section 5101 requires providers to transfer title of oxygen equipment to beneficiary after 36 continuous months

36 month rental period began on January 1, 2006

www.cms.hhs.gov/HomeHealthPPS/downloads/CMS1304F


BBA requires budget neutrality Proposed monthly oxygen payments:

2007- 2008 = $198.40 /mo 2009 = $193.21 /mo 2010 = $189.39 /mo 2007 oxygen content will increase = $77.45 /mo 2007 add-on for transfilling equipment and

portable oxygen concentrators = $51.63


Maintenance/service will be paid if reasonable and necessary and based on criteria determined by the Secretary CMS will pay for M&S visits Q 6 months for

pt owned equipment CMS will pay for “loaner” while pt owned

equipment is repaired CMS will pay for supplies (NC, tubing, etc)


Impact on beneficiaries Saves Medicare money Should not increase beneficiary out of

pocket expenses


Supplier requirements Furnish the item throughout the entire

rental period If switch-out required, replace with

equipment of equal or greater value Replace equipment that doesn’t last for

reasonable ‘lifetime’ Disclosure of intentions re: accepting

assignment

OIG Advisory Opinion# 06-20 (posted 11/08/06)

It is a violation of the Civil Monetary Penalties Act (CMP) and a violation of the Anti-kickback Statute to: Provide Medicare patients with free home

oxygen until the patient qualifies for coverage

Provide Medicare patients with free overnight oximetry testing

What We Can Do

The AARC will continue to advocate on behalf of our patients thru the efforts of our Government Affairs and PACT committees

Our efforts can make more of an impact with your participation

435 Activation

December 2005: AARC asked the PACT chairs to activate the 435 committee in each state

Committee members were asked to contact Congressmen to urge members of Congress to vote “NO” on S1932

The Response…

In the first two days there were over 1000 messages sent to Congress thru Capitol Connection, 6000+ messages in five weeks

75% of the States responded that they activated their plan during the holiday week

S 1932 Not on the winning side of the vote

Washington did hear us loud and clear Nine (9) Republicans voted against S.1932 the

first time around….Thirteen (13) voted against it on 2/1/06

AARC will continue to monitor the creation of the rules and regulations regarding the DME issue Our goal is to make sure we have input on

behalf of our patients

Please Join the Effort! Political

Become informed about issues that affect access to care

Advocacy Speak out on behalf of our patients

Contact Phone, write, e-mail, visit our legislators

Team Participate!

How to Use Capitol Connection

Go to www.aarc.org Click on Advocacy Enter your zip code to find your legislators Choose your topic and use the talking points

to write your message in the text box Make sure to include your name, voting

address, phone number and e-mail Hit send

Questions?

[email protected]

[email protected]

2006 Legislative Impact on Home Care Joan Kohorst, MA, RRT Apria Healthcare AARC Home Care Section...

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