Power Chair Coverage Tightened, But Scooter Coverage May Loosen
A policy clarification notice posted by the four DME Regional Carriers (DMERCs) in December is not just clarifying policy, it is changing it, says the American Association for Homecare (AAHomecare) and some of the country’s largest power wheelchair manufacturers, including Invacare Corp, Sunrise Medical, and Pride Mobility.

The clarification, which is part of the Centers for Medicare and Medicaid Services (CMS) Operation Wheeler Dealer 10-point plan to curb fraud and abuse in Medicare power wheelchair billing, alters the long-standing policy of providing power wheelchairs based on the patient’s ability to perform activities of daily living within the home without a power wheelchair to a much stricter interpretation that requires the patient to be almost completely nonambulatory to qualify for a power wheelchair. “If the patient is able to walk either without any assistance or with the assistance of an ambulatory aid, such as a walker, the power wheelchair is denied as not medically necessary,” the bulletin states.

But as the DMERCs worked to tighten the coverage policy, CMS made plans to begin allowing all physicians, and not just certain specialists, to prescribe power operated vehicles (POVs)—commonly known as scooters—instead of the more expensive power wheelchairs. “CMS apparently thinks a lot of people who want a scooter are getting a power chair because that is what their physicians can prescribe,” says Timothy Webster, an attorney with Amarillo, Tex-based law firm Brown & Fortunato PC.

Because the new rule is also part of CMS’s Operation Wheeler Dealer 10-point plan, it is on a fast track, Webster says. According to CMS’s Unified Agenda of Regulatory Actions, the rule will skip the normal comment period that goes on after a notice of proposed rule making is issued and will instead be put out as an interim final rule with a comment period in February. “That way it goes into effect immediately,” Webster says.

At press time, AAHomecare’s staff was trying to get a preliminary copy of the rule so they could review it. “I really think it will be a good thing for the industry because it will allow physicians more flexibility in what they prescribe,” says Seth Johnson, director of public policy for AAHomecare. However, he adds that the association is planning to review the rule carefully to make sure that it will not go too far and force physicians into prescribing scooters for people who really need power wheelchairs.

Scully Leaves CMS After resigning in December, former Centers for Medicare and Medicaid Services (CMS) Administrator Tom Scully joined Alston & Bird, an Atlanta-based law firm that represents the National Association for Home Care and Johnson & Johnson, among others. According to the Reuters news service, Scully intended to step down as CMS administrator last summer but was persuaded by US Department of Health and Human Services (HHS) Secretary Tommy Thompson to hold the position until the Medicare bill had passed. Thompson appointed Dennis G. Smith, head of the Center for Medicaid and State Operations, to act as CMS head until a new administrator is nominated and sworn in. Leslie V. Norwalk, CMS deputy administrator and COO, will continue to lead CMS in carrying out the Medicare legislation signed into law by President George W. Bush on December 8, according to Thompson. Even while working on the Medicare bill, Scully was already in high demand by at least five law firms, which participated in a bidding war to gain the former administrator’s advisory service for clients affected by the Medicare law, according to The New York Times. In May 2003, Thompson approved a waiver to exempt Scully from certain parts of federal ethics laws, which require that employees who have begun seeking private work cease working on “any official matter” that involves a prospective employer, according to the Times. Scully, who was appointed to the CMS post by Bush in May 2001, will work in the Alston & Bird Washington, DC, office as a senior counsel. “I am very sorry to see Tom Scully leave,” says American Association for Homecare President and CEO Kay Cox, “AAHomecare has had a great relationship with him—as a matter of fact, he will be our keynote speaker at our Leadership Conference this month. But we are very pleased with Secretary Thompson naming Dennis Smith as the acting administrator. Dennis knows Medicaid and was instrumental on working for CMS on the Hill during passage of the new Medicare reform law.”

Congressman Visits VGM
The member services organization The VGM Group wasted no time in meeting with its congressman, Jim Nussle (R-Iowa), after Nussle voted for the Medicare Prescription Drug, Improvement, and Modernization Act of 2003, which VGM had opposed because it contained cuts in reimbursement for home health care products and competitive bidding. On December 17, Nussle, who is chairman of the House Budget Committee, and his aide Joe Huber met for 2 hours with VGM’s leadership. But they were not meeting so VGM could register its displeasure with Nussle’s December 8 vote, says John Gallagher, VGM’s vice president of government relations. Instead, this was a strategy and information-gathering meeting.

VGM representatives (back row from left) Jim Walsh, John Gallagher, Mark Higley, Mike Mallaro, and Ron Bendell discussed issues facing HME providers with Iowa congressman Jim Nussle (bottom row, right) and his aide Joe Huber.

“Following the vote, Nussle’s office had contacted us and let us know what was transpiring, so he had been very communicative with us,” Gallagher says. “We understood the politics of why he voted yes.”

According to Gallagher, VGM filled Nussle in on their concerns about next year’s proposed cuts to the reimbursement on certain home health care products based on the Federal Employees Health Benefits Program average prices, and some of the consequences of the Centers for Medicare and Medicaid Services (CMS) power wheelchair fraud crackdown.

Nussle had not been aware of the industry’s efforts to stop the fraud in Houston and wanted to set up a later meeting to get more information about why CMS had not acted when companies, such as VGM, had alerted it to the fraud problems, Gallagher says.

In the meeting at VGM’s Waterloo, Iowa, headquarters, they also discussed the possibility of having national competitive bidding removed from the new Medicare act in a corrections bill. “He was honest with us and said to not look for it to be at the top of next year’s agenda because of the politics involved,” Gallagher says.

Should legislators introduce a corrections bill in 2004, it would likely be to remove the Medicare act’s ban on importing cheaper drugs from Canada, but Gallagher believes that could be to the industry’s advantage. “We could slip our issues in under the radar,” he says.

Medtrade Spring Reacts to Medicare Reform
In the wake of the Medicare Prescription Drug, Improvement, and Modernization Act of 2003, the home health care industry’s second largest trade show—Medtrade Spring, March 16-17 in Las Vegas—has adjusted its offerings to provide more information on dealing with the changes the law may bring. Chief among the additions is the Accreditation Summit, which the Medtrade show organizer, VNU Expositions, will present on Tuesday, March 16, from 1 pm to 4 pm at the Las Vegas Convention Center to help show attendees prepare for the law’s national accreditation requirements.

In addition, the trade show exhibit hall, which will be open Wednesday, March 17, from 10 am to 5 pm and Thursday, March 18, from 10 am to 3 pm, will include a state association and grassroots lobbying area sponsored by Medtrade and Home Health Care Dealer/ Provider. Called The Advocates Corner, it will allow attendees to explore online lobbying resources and gain information about becoming politically involved with their state and national associations to effect changes in legislation with which they do not agree.

Finally, keynote speaker Bruce Vladek, former administrator of the Health Care Financing Administration (which later became the Centers for Medicare and Medicaid Services), will likely address the impact of the legislation as part of his presentation on the future of Medicare on Wednesday, March 17, at 7:30 am.

For more information on the show, including its traditional educational offerings, its Continuum of Care educational program, its exhibiting companies, and registration, visit www.medtradespring.com or call (800) 933-8735.

Scully To Speak at AAHomecare Conference
Tom Scully, who left his job as Centers for Medicare and Medicaid Services (CMS) administrator 2 months ago, will bring his first-hand knowledge of the Medicare Prescription Drug, Improvement, and Modernization Act of 2003 to the American Association for Homecare’s Leadership Conference and IT Summit in Rancho Bernardo, Calif, this month.

His presentation, “The New Medicare Law: What Now?” will come on Friday, February 27, the last day of the 3-day conference, and is likely to be of great interest to AAHomecare members concerned about the new Medicare law’s reimbursement cuts, plans for national competitive bidding, and national accreditation requirements.

The conference also will feature information on cost cutting using better billing and reimbursement operations, management techniques and technologies, as well as political planning and fund raising. For more information, visit www. aahomecare.org/meetings/leader ship-sched2004.html or call (703) 836-6263.