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.

No commentary. The quote speaks for itself.

In testimony before the House Ways and Means Subcommittee on Health, the American Association for Homecare (AAHomecare) will urge Congress to suspend a controversial, flawed Medicare bidding program for home medical equipment, calling it “a train wreck.”

The congressionally mandated “competitive bidding” program was designed to reduce the number of homecare providers and reduce reimbursement rates for oxygen therapy, hospital beds, wheelchairs, and other types of home-based equipment and care in Medicare.

With a smashing success, the American Association for Homecare’s rehab and assistive technology council (RATC) claimed a victory this week when three senators introduced the Medicare Access to Complex Rehabilitation and Assistive Technology Act of 2008. Senators Tim Johnson (D-SD), Olympia Snowe (R-Me), and Debbie Stabenow (D-Mich) introduced the bill, dubbed S 2931, that would exempt complex rehabilitation from Medicare competitive bidding.

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.

Even though the Medicare National Coverage Determination for Mobility Related Equipment was revamped in 2005, many providers and suppliers continue to be perplexed by complex policy requirements and strict protocols for physician and clinician documentation using the algorithmic approach to qualify the appropriate level of Mobility Assistive Equipment (MAE). Additionally, recent audit outcomes in Jurisdiction A and B highlight the need for targeted education to insure future provider and supplier compliance.

The American Association for Homecare is jointly sponsoring a workshop and online webinar with the University of Pittsburgh Medical Center called “Best Practices and Clinical Documentation for Mobility Assistive Equipment” on May 29, 2008 from 1:00 p.m. to 5:00 p.m. The workshop will take place at the University of Pittsburgh in Pittsburgh, Pa.

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.

From Peter Bauer, Dept. Health and Human Services:

You may have heard that Congress changed the way that Medicare determines how much it pays for certain durable medical equipment, prosthetics, orthotics and supplies (DMEPOS) and who can furnish these items. Starting in July 2008, you’ll begin to see the effect of a new Competitive Bidding Program in certain areas of the country. Here’s what you need to know about this new program.

Who will be affected by the new Competitive Bidding Program?

The new Competitive Bidding Program applies to you if your permanent residence is in a zip code that is part of a Competitive Bidding Area (CBA), or if you get certain items while visiting a CBA. Your permanent residence is the address where Social Security mails your benefits check. The following areas will be initially affected:

* Charlotte-Gastonia-Concord, NC-SC * Cincinnati-Middletown, OH-KY-IN * Cleveland-Elyria-Mentor, OH * Dallas-Fort Worth-Arlington, TX * Kansas City, MO-KS

* Miami-Fort Lauderdale-Miami Beach, FL * Orlando-Kissimmee, FL * Pittsburgh, PA * Riverside-San Bernardino-Ontario, CA * San Juan- Caguas-Guaynabo, PR

To find out if your zip code is included in a CBA, call 1-800- MEDICARE

(1-800-633-4227). TTY users call 1-877-486-2048. You can also search CBAs and zip codes by visiting www.medicare.gov on the web. The program is scheduled to expand to 70 additional areas in 2009. ★

What is the Competitive Bidding Program?

The new Competitive Bidding Program lets Medicare use competitive bids submitted by suppliers to determine the amount Medicare pays for certain medical equipment and supplies. The program will help save you money; ensure that you can get quality medical equipment, supplies and services; and help limit fraud and abuse in the Medicare program.

How does this new program work?

Under the new Competitive Bidding Program, suppliers who do business in a Competitive Bidding Area (CBA) must submit a bid in order to be awarded a contract to sell to people with Medicare. Contracts will only be awarded to those suppliers who offer the best price; who meet Medicare’s eligibility, quality and financial standards; and who are accredited by an independent accrediting organization. These suppliers are called “contract suppliers.”

In most cases, only contract suppliers will be able to provide people with Medicare with certain items and file claims with Medicare for payment. Contract suppliers can’t charge more than the single payment amount set by Medicare based on the bids received for an item, and this price can’t be higher than the current Medicare (fee schedule) allowed amount.

How do I know if my equipment or supplies are included in the Competitive Bidding Program?

Ten product categories are included in the Competitive Bidding Program:

* Oxygen supplies and equipment

* Standard power wheelchairs, scooters, and related accessories (includes wheelchair cushions)

* Complex rehabilitative power wheelchairs and related accessories (includes wheelchair cushions)

* Mail-order diabetic supplies

* Enteral nutrients, equipment, and supplies

* Continuous Positive Airway Pressure (CPAP) devices and Respiratory Assist Devices (RADs) and related supplies and accessories

* Hospital beds and related accessories

* Negative pressure wound therapy devices and related supplies and accessories

* Walkers and related accessories

* Group 2 support surfaces, including mattresses and overlays (in Miami-Fort Lauderdale-Miami Beach and San Juan-Caguas- Guaynabo only)

To check if an item you use is included in the program, call 1-800- MEDICARE (1-800-633-4227) or visit www.medicare.gov on the web. TTY users call 1-877-486-2048. ★

Do I have to get any new supplies or equipment that I need from a contract supplier?

If the equipment or supplies ordered by your physician or treating practitioner are included in the Competitive Bidding Program where you live, you must get your equipment or supplies from a contract supplier. However, your doctor or treating practitioner can supply certain items, including a walker, to you as part of his or her professional service even if he or she is not a contract supplier. If you live in a Skilled Nursing Facility or Nursing Facility, your facility may be able to supply your equipment or supplies directly if it becomes a contract supplier. If your facility does not become a contract supplier, it must use a contract supplier from the CBA.

If you travel to or visit an area that is included in the Competitive Bidding Program and need to get equipment or supplies that are part of the Competitive Bidding Program for that area, you must get those items from a contract supplier for that area.

What if I need a specific brand of item or supply?

If you need a specific brand of equipment or supplies, or you need the item in a specific form, your doctor must prescribe the specific brand or form in writing. Your doctor must also document in your medical record that you need this specific brand or form for medical reasons.

Your contract supplier will fill your doctor’s prescription as written. If the item isn’t available, the supplier will either work with your doctor or treating practitioner to find an appropriate alternative, or help you locate another contract supplier who can meet your needs.

How will I know if my supplier is a contract supplier?

To see a list of the contract suppliers in your area or to check if a supplier you use is included in the program, call 1-800-MEDICARE (1-800-633-4227) or visit www.medicare.gov on the web. TTY users call 1-877-486-2048. A Supplier Locator Tool on www.medicare.gov will help you locate a DMEPOS contract supplier in your area.

Do I have to change doctors?

No. The Competitive Bidding Program does not affect which doctors you can use. ★

Do I have to change suppliers if my current supplier was not awarded a contract?

You may have to change suppliers to continue having Medicare pay for your item, but the earliest you would have to change would be July 2008. However, if you are currently renting certain medical equipment or oxygen, you may have the choice to stay with your current supplier. Non-contract suppliers can become “grandfathered” suppliers and continue to rent items to people with Medicare who permanently live in a CBA if they rented the item to a person prior to the new Competitive Bidding Program. When you use a grandfathered supplier, you are still responsible for a 20% copayment and any unmet Part B deductible.

If your current supplier of rented equipment decides not to be a grandfathered supplier, you must switch to a contract supplier instead.

Does the Competitive Bidding Program change the way I get my equipment repaired or replaced?

For medical equipment you own, you can use any Medicare-enrolled supplier to make necessary repairs or get replacement parts for the equipment. If your item needs to be completely replaced, you will need to get the replacement item from a contract supplier.

Do I still have to meet my deductible and pay my 20% coinsurance?

Yes. You are still required to meet your annual deductible. After you have paid your annual Part B deductible, Medicare pays 80% of the Medicare-approved amount for equipment, supplies and services, and you are responsible for a 20% coinsurance.

It is important to remember that for any equipment or supplies that are included in the Competitive Bidding Program, the contract supplier cannot charge you more than the 20% coinsurance and any unmet annual deductible. If you suspect that you are paying more coinsurance than the Medicare allowed amount, you can call 1-800-MEDICARE (1-800-633-4227) or call the Fraud Hotline of the HHS Office of the Inspector General at 1-800-447-8477.