ARLINGTON, Va., June 16 /PRNewswire-USNewswire/ — The American Association for Homecare (AAHomecare) applauded Congressional efforts to pass a bill introduced last week that will delay for at least 18 months the controversial and flawed Medicare competitive bidding program for home medical equipment and services. The bill, H.R. 6252, is titled the “Medicare DMEPOS Competitive Acquisition Reform Act of 2008.”

The competitive acquisition or “competitive bidding” program for durable medical equipment, prosthetics, orthotics, and supplies (DMEPOS) is
scheduled to begin on July 1, 2008 in ten metropolitan areas: Charlotte, NC; Cincinnati, Ohio; Cleveland, Ohio; Dallas - Ft. Worth, Texas; Miami,
Fla.; Orlando, Fla.; Pittsburgh, Pa.; Riverside, Calif.; and San Juan, P.R. The bidding program applies to oxygen therapy, mail-order diabetic
supplies, power wheelchairs, CPAP equipment, hospital beds, and several other categories of durable medical equipment and services used by Medicare beneficiaries in their homes. The program is scheduled to expand to 70 additional areas in the U.S. in 2009.

The reform bill, H.R. 6252, would delay the program for at least 18 months in order to improve the program. The lead cosponsors are House Ways and Means Committee health subcommittee chair Pete Stark (D-Calif.) and subcommittee ranking member David Camp (R-Mich.). View the text at http://www.aahomecare.org.

According to a press release issued by Congressmen Stark and Camp, the bill would require the federal Centers for Medicare and Medicaid Services (CMS) to “improve the program for both beneficiaries and suppliers. The cost of the delay and accompanying reforms is fully paid for within the DME sector by reducing payment rates for covered items by 9.5 percent nationwide starting in 2009, but provides for an additional increase of 2 percent in 2014.”

Congressman Stark stated in the release, “I’m pleased to introduce this bipartisan bill and look forward to working with my colleagues for its
swift passage so that the program can be redesigned to meet the needs of patients, providers and taxpayers.” He added, “This is no free lunch. This bill requires the DME industry to finance the cost of delaying the program.”

In the same press release, Congressman Camp states, “The implementation of this necessary program has been flawed and needed to be fixed. This bill provides us with the time to get the program right and ensure we are reducing costs while protecting beneficiaries in the long run.”

In addition to Stark and Camp, other cosponsors of the bill include Ways and Means Chair Charles Rangel (D-N.Y.), Republican Minority Leader
John Boehner (R-Ohio), Energy and Commerce Committee Chair John Dingell (D-Mich.), Energy and Commerce subcommittee chair Frank Pallone (D-N.J.) and two dozen other Representatives.

American Association for Homecare President Tyler J. Wilson added, “We are grateful for the leadership of Congressmen Stark and Camp on this issue of immense importance to the homecare community. This bill is critical to making important improvements to Medicare policy that will protect
America’s seniors and people with disabilities who depend on home medical equipment and services in their homes. If allowed to go forward, the
bidding program will put thousands of qualified homecare providers out of business and reduce patients’ access to quality home medical equipment and services. Homecare is cost-effective and represents the smallest and slowest-growing sector of Medicare. We applaud efforts to preserve quality care in the home.”

Organizations supporting H.R. 6252 were listed in the press release issued by Congressmen Stark and Camp. They include:

— American Academy of Physical Medicine and Rehabilitation
— American Association for Homecare
— American Podiatric Medical Association
— American Society of Transplantation
— Consortium for Citizens with Disabilities Health Task Force
— Health Industry Distributors of America
— Independence Through Enhancement of Medicare and Medicaid (ITEM) Coalition
— National Coalition for Assistive and Rehab Technology
— National Community Pharmacists Association
— Orthotic and Prosthetic Alliance
— Pedorthic Footwear Association
— The Endocrine Society
— Vision Council of America
— Wound Ostomy Continence Nurses Society

Contacts: Michael Reinemer, 703-535-1881; michaelr@aahomecare.org; Tilly Gambill, 703-535-1896; tillyg@aahomecare.org

The American Association for Homecare represents providers, equipment manufacturers, and other organizations in the homecare community. Members serve the medical needs of millions of Americans who require oxygen equipment and therapy, mobility assistive technologies, medical supplies, inhalation drug therapy, home infusion, and other medical equipment and services in their homes. Membership includes providers of all sizes operating approximately 3,000 locations in all 50 states. See http://www.aahomecare.org.

Sadly, many amputees end up on the wrong side of a decision making process when undergoing “elective” amputation, such as the type of elective surgery a person with cancer may choose to make. The decision isn’t whether or not to go ahead with the surgery, but the decision of the beancounters at your typical insurance company. Read on.

SOUTH BURLINGTON, Vt. - After bone cancer forced the amputation of her right leg below the knee, Eileen Casey got even more bad news: Her insurer told her that she had spent her $10,000 lifetime coverage limit on her temporary limb and that the company wouldn’t pay for a permanent one.

“It was shocking to find out I was going to have to take out a loan to buy myself a leg so I could keep working and living independently,” Casey said. At the bank, she said, she burst into tears when they asked what the loan was for.

Since then, Casey has joined a nationwide fight by amputees and the prosthetics industry to get the states and Congress to require fuller coverage for artificial limbs. The insurance industry is fighting the effort, saying such mandates drive up costs and reduce the flexibility customers want.

The Centers for Medicare & Medicaid Services (CMS) proposed a rule that will improve the accuracy of payment for services furnished to people with Medicare who need the intensive rehabilitation services provided by Inpatient Rehabilitation Facilities (IRFs). These include patients who are recovering from serious illnesses or injuries, such as stroke, spinal cord injuries, severe burns, amputations and a number of other conditions. There are currently more than 1,200 facilities that are paid as IRFs.

It seems that in some instances maggots are able to single…um…maggotedly reduce the incidence of amputation and resulting disability more frequently than traditional techniques. Maggot therapy isn’t really anything new — it’s been well documented amongst veterans of wars since the 1200s. But it’s no less disgusting than it always has been. At any rate, Medicare is considering covering prescriptions for medical maggots. Ick!

Members of the BioTherapeutics, Education and Research (BTER) Foundation disagree with the CMS recommendation, and plan to demonstrate that beneficiaries, health care professionals and taxpayers do see a need for patients and their doctors to be able to use, code, and be reimbursed for using medicinal maggots. According to the charity’s director, Dr. Ronald Sherman, BTER Foundation representatives will remind CMS officials that the same efficacy and safety studies that FDA evaluated before clearing Medical Maggots for marketing in the U.S. also demonstrated lower medical costs and high rates of limb salvage. In fact, when used on patients who failed all other medical and surgical treatments for their gangrenous wounds were offered only amputation or maggot therapy, 40-50% of patients who chose maggot therapy healed their wounds and saved their limbs. BTER Foundation members also will present study data that shows that many doctors will not prescribe maggot therapy when their insurance companies do not, or are perceived not to reimburse for the maggots. “Not having a reimbursement code for medicinal maggots is like not allowing maggots on the formulary of any insurance company,” he says. “This is not what we would expect from Medicare, as the leading proponent of high-quality, equitable, cost-efficient medical care.“

Medical News Today reports that the newly announced Medicare DME program adopted after Congressional mandate, has already hit snags in 10 major metorpolitan areas, with more expected in 2009.

A new Medicare bidding program for durable medical equipment (DME) scheduled to be implemented in 10 metropolitan areas starting on July 1, 2008 will put many DME providers out of business and will disrupt services for many of the three million seniors and people with disabilities living in those areas.

Those areas include Charlotte, N.C.; Cincinnati, Ohio; Cleveland, Ohio; Dallas-Ft. Worth, Texas; Kansas City, Mo; Miami, Fla.; Orlando, Fla; Pittsburgh, Pa.; Riverside, Calif., and San Juan, P.R. Another 70 metropolitan statistical areas have been targeted for implementation of the bidding program in 2009.

Last Friday, DME providers in the first ten competitive bidding regions received letters from the Centers for Medicare and Medicaid Services (CMS) explaining whether they had been offered a contract, been disqualified from bidding, or bid outside of the bidding range for a product. Those DME providers that did not receive contracts for a given Medicare item or service are shut out of the Medicare program for three years.

Medical News Today reports:

Thousands of Medicaid beneficiaries who were previously limited to receiving care in an institutional setting may now be given the option to receive that care in their homes and communities, under a proposed rule published by the Centers for Medicare & Medicaid Services (CMS).

The Deficit Reduction Act of 2005 (DRA) gave states a new option to provide home-and-community based services (HCBS) to Medicaid beneficiaries without applying for a demonstration waiver. The proposed rule provides guidance to states on how to implement this provision of the DRA.

Under this option, states will now be able to set their own eligibility or needs-based criteria for providing HCBS. Previously, to qualify for assistance with personal care, home health care or other services in the home or community setting, beneficiaries were required to be at imminent risk of institutionalization. The DRA provision eliminates this requirement and allows states to cover Medicaid recipients who have incomes no greater than 150 percent of the federal poverty level, or $15,600 per individual in 2008, and who satisfy the needs-based criteria.

Victoria Hollingsworth, a newscaster in the UK, broke her back in a car accident three years ago. During her post-operative care, she learned that many people injured in accidents become homeless due to a lack of insurance funding to modify their existing homes. Victoria is making an effort to raise public awareness regarding the unspoken consequences of becoming disabled in the UK and worldwide.

Toward this end, Victoria is engaging in a series of public speaking events, and has sought professional management to help her spread the word about the “extras” that the critically injured patient needs from their insurance firms.

Victoria says many patients cannot go back to their homes due to the lack of wheelchair access and have to be housed elsewhere.

She said: “I know of a girl around my age who was paralyzed following an accident and had to live in an old people’s home for 18 months.

“Can you imagine your state of mind - coming to terms with life in a wheelchair and having to do that surrounded by people four times your age?

“There is also the story of man who was a new father immediately prior to his accident. His council housed him in a hotel and he rarely got to see his wife and baby.

“She worked full time and he couldn’t afford to eat in the hotel so had to rely on eating take-away food as he had no access to a kitchen.”

Every year around 1,000 people sustain a spinal cord injury, according to the Spinal Injuries Association (SIA).

Aspire, a charity which helps people with spinal injuries, says around two thirds of people could face housing problems after spending between six and 18 months in spinal centres.

Think you’re insured? Think again. Debbie Shank, an employee of Wal-mart and beneficiary of it’s self-insurance plan, is being sued by the coporate mega-giant to recover medical fees they supposedly covered under her insurance plan. Debbie, awarded a sum of roughly $900,000 to cover her nursing home care costs for the rest of her life, received a bit over $400,000 once all was said and done with fees. Wal-Mart expects Debbie and her husband to take her settlement and reimburse them for all medical expenses they have already paid, leaving her with very little left — and a lifetime of nursing home care to look forward to.

Displeased? Write or call Wal-Mart, not Wal-Heart, at:

Wal-Mart Stores, Inc.
Bentonville, Arkansas 72716-8611
Media Relations: 1-800-331-0085

CNN has a video and interview with Ms. Shank. Excerpt:

JACKSON, Missouri (CNN) — Debbie Shank breaks down in tears every time she’s told that her 18-year-old son, Jeremy, was killed in Iraq.

Even though the 52-year-old mother of three attended her son’s funeral — she continues to ask how he’s doing. When her family reminds her that he’s dead — she weeps as if hearing the news for the first time.

Shank suffered severe brain damage after a traffic accident nearly eight years ago that robbed her of much of her short-term memory and left her in a wheelchair and living in a nursing home.