CMS May Drastically Reduce Inhalation Drug Reimbursement
In the August 5 Notice of Proposed Rule Making, CMS proposed an 89% cut in reimbursement for albuterol sulfate and ipratropium bromide, but asked for comment on appropriate dispensing fees for the drugs. CMS says that Medicare spending for the drugs, commonly used to treat respiratory disorders such as chronic obstructive pulmonary disease (COPD), increased by 77% between 2001 and 2003.

In response to the announcement, large home respiratory providers Apria, Lincare, and American HomePatient threatened to stop providing the drugs starting in 2005 without a significantly higher dispensing fee or some type of service fee for providing inhalation drugs.

The Medicare Prescription Drug, Improvement, and Modernization Act (MMA) of 2003 requires that certain drugs be reimbursed under a new formula beginning in January 2005 based on average sales price plus 6%, but the proposed cuts would curtail beneficiaries’ access to those therapies, says the American Association for Homecare (AAHomecare).

“Medicare beneficiaries must continue to have access to critical inhalation therapies,” says Kay Cox, president and CEO of AAHomecare. “The home care community will continue to work closely with CMS and Congress as a resource to make sure that reimbursements are not reduced to a point where beneficiaries lose access to care.”

Tim Pontius, chair of the AAHomecare Board of Directors and president and CEO of Young Medical Services in Toledo, Ohio, called the proposed 89% cuts “absurd.”

“We are continuing to commit a lot of time and resources to combat the current proposal and arrive at a reimbursement that would allow our industry to still provide respiratory meds in 2005—not just nationals, but independents, particularly since we service rural markets the nationals do not have good representation within.”

CMS Proposes Power Wheelchair Coding Revisions
As promised in its April three-pronged power wheelchair initiative, CMS has proposed new codes for power wheelchair billing.

Under the coding proposal, K0010, K0011, K0012, and K0014 would be combined and the individual products split into three basic categories: standard, heavy duty, and bariatric. Each of those categories would contain multiple subgroups

for “body habitus and chair functionality characteristics.” CMS says the code groupings account for about 95% of

the typical code combinations billed for under the K0010, K0011, K0012, and K0014 power bases. Every chair would come with a Basic Equipment Package, which would include accessories such as straps, anti-tippers, anti-rollback brakes, and batteries.

The standard wheelchair category refers to chairs for patients up to and including 300 pounds; its subcategories are portable lightweight, standard, standard-wide, standard-rehab, standard-wide-rehab, and standard-rehab-high activity. Patients weighing 301 pounds to 450 pounds with a “stable condition that renders them non-ambulatory” can be billed for a heavy duty chair; its subcategories are heavy duty-wide, heavy duty-rehab, and heavy duty-rehab-high activity. Bariatric chairs are for patients from 451 pounds to 600 pounds; its subcategory is bariatric-rehab.

At press time, the National Coalition for Assistive and Rehab Technology (NCART), which supports the power mobility coding structure proposal developed by the Power Mobility Coding Task Force and submitted to CMS in March 2003, had not yet released a formal comment on the proposed codes. However, Sharon Hilde-

brandt, executive director of NCART, called the CMS proposal structurally different from that submitted by the Power Mobility Coding Task Force, a group composed of power wheelchair suppliers and manufacturers and other groups that worked for 2 years to develop its coding proposal with input from clinicians.

“Our [code proposal] matches up clinical indicators with the technology that is out there,” says Hildebrandt. “The CMS power wheelchair proposals basically base their codes on the current codes.”

In developing the new code proposal, CMS reviewed a 1-year Statistical Analysis DMERC survey of national power wheelchair data. Hildebrandt says CMS needs to consider all payors, not just Medicare. She also noted that the proposal did not include codes for pediatric power wheelchairs.

On September 1, CMS is holding a public meeting on the power wheelchair code proposal in Baltimore with a scheduled time for open public comment. To read the full text of the proposal, visit www.cms.hhs.gov/medicare/hcpcs/SADMERC_PWC.pdf.

Coram Signs Home Infusion Agreement With Humana
Coram Healthcare is now the preferred provider of specialized home infusion, respiratory therapy, and HME for Humana Inc members. The national agreement between Coram and Louisville, Ky-based Humana went into effect July 1. In combination with existing agreements between Coram and Humana’s national network, Humana/ChoiceCare, and Humana Military Healthcare Services subsidiaries, Coram now provides services to 5.8 million members nationwide.

VGM Holds Profitable Charity Golf Tournament
The annual VGM Celebrity Invitational Golf Tournament raised $61,152 for Adults Inc, a Waterloo, Iowa-based agency that helps individuals with disabilities live and work in the community. Costs for the tournament, held August 6 in Waterloo, VGM & Associate’s home town, were underwritten by the group purchasing organization so that 100% of the monies raised went to Adults Inc. Since its inception in 1997, the tournament has raised $238,550 for Adults Inc.

In other recent VGM news, Louis Feuer will be offering a 11¼2-day Sales Training University in December and VGM LEARN (Learning, Education And Research Network) is launching its first Spanish-translated course at its virtual university.

The Sales Training University will be held December 1-2 in Atlanta. A sales and marketing expert with more than 30 years of HME industry experience, Feuer will present the sales training program developed for new and experienced sales and marketing staff. In 2005, the Sales Training University will be presented in San Diego, Houston, New York, and Waterloo. For registration and information, contact: Sara Bauer, director of education, VGM & Associates, at (888) 797-8672 or Louis Feuer, president, Dynamic Seminars & Consulting Inc, at (954) 435-8182.

VGM LEARN’s new Spanish course, “How HME Works,” or “Cómo funciona el HME (Equipo médico del hogar),” will cover who uses HME and why, the financial aspects of the products and services related to HME, and who regulates the industry. VGM says it soon will be offering more Spanish language education programs that will incorporate online learning, live seminars, and teleconferences.

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