CMS Sets Deadline for Power Chair Test
As CMS sets to establish fee schedule amounts for the new HCPCS codes by January 1, 2006, the agency has set September 1, 2005, as a deadline for manufacturers to submit test results for power chairs and scooters. Test results and a completed application for coding verification must be submitted to the Statistical Analysis Durable Medical Equipment Regional Carrier (SADMERC) where analysts will determine the appropriate code placement for each product. “If sufficient information is not available to establish a fee schedule amount for a code, payment may be made on the basis of individual consideration of each claim until the necessary information is obtained,” says a CMS announcement. “Medicare will not pay for products under the old codes after January 1, 2006, and will not pay for products under the new codes that have not been tested and have not received a coding verification from the SADMERC.”

MEDIchair Calgary Receives Glen Matheson Award MEDIchair Calgary, Calgary, Alberta, Canada, recently received the Glen Matheson Award, the highest provincial honor bestowed by the Alberta Easter Seals March of Dimes for helping improve the quality of life for people with physical disabilities. “One recipient of mobility equipment wrote to tell us that MEDIchair Calgary’s contribution had completely reversed their life of isolation to one of newfound independence,” says Susan Law, executive director, Easter Seal Ability Council. “That’s a very powerful statement and a contributing factor to why MEDI-chair Calgary is a very deserved recipient of our highest award.”

Mandatory Electronic Medicare Claims Set for July
Starting July 5, 2005, CMS will process only electronic claims. Paper claims will not be accepted unless providers submit an explanation for paper processing and their justification is approved. According to a Change Request transmittal posted in January, “Entities determined to be in violation of the statute or this rule may be subject to claim denials, overpayment recoveries, and applicable interest on overpayments.”

CMS Creates New Medicare Jurisdictions
In changing the Medicare fee-for-service program’s administrative structure, CMS has drawn up new Medicare Administrative Contractor jurisdictions, including reconfigurations for the DMERCs. The result of these changes will be “jurisdictions that reasonably balance the number of fee-for-service beneficiaries and providers,” according to CMS.

Central to the contracting reformation is the integration of new claims payment contractors called Medicare Administrative Contractors or MACs. According to CMS, the integration of MACs will centralize information and benefit Medicare’s enrollee population as it increases. Under the new MACs, most beneficiaries will have their claims processed by only one contractor, primary A/B MACs will be required to develop an integrated approach to medical coverage, and beneficiaries will be able to have their questions answered by a single point of contact at (800) MEDICARE, a CMS statement says. Also, competition will encourage MACs to deliver better service, including accurate and consistent payment decisions. Under CMS’ current schedule, the full fee-for-service workload will be transitioned to MACs by October 2009.

The new MAC jurisdictions include:
Region A: Connecticut, Delaware, District of Columbia, Maine, Maryland, Massachusetts, New Hampshire, New Jersey, New York, Pennsylvania, Rhode Island, and Vermont.

Region B: Illinois, Indiana, Kentucky, Michigan, Minnesota, Ohio, and Wisconsin

Region C: Alabama, Arkansas, Colorado, Florida, Georgia, Louisiana, Mississippi, New Mexico, North Carolina, Oklahoma, Puerto Rico, South Carolina, Tennessee, Texas, US Virgin Islands, Virginia, and West Virginia.

Region D: Alaska, American Samoa, Arizona, California, Guam, Hawaii, Idaho, Iowa, Kansas, Missouri, Montana, Nebraska, Nevada, North Dakota, Northern Mariana Islands, Oregon, South Dakota, Utah, Washington, and Wyoming.

New K Code From CMS
CMS has issued new reimbursement guidance for a new class of portable oxygen concentrators that serve as a single solution for a patient’s long-term oxygen therapy needs. According to a recent CMS bulletin, “Code K0671 describes a portable oxygen concentrator system and is to be used when billing Medicare for the portable equipment add-on fee for patients using lightweight oxygen concentrators that can function as both the patient’s stationary equipment and portable equipment.” Providers can begin billing for the new code April 1. K0671 is used in combination with E1390 to identify and insure appropriate coverage of both the stationary and portable applications of the oxygen system.

Public Divided on EMR Privacy Risks
US adults are sharply divided on whether the potential privacy risks associated with a patient electronic medical record (EMR) system outweigh the expected benefits, according to poll results given to the National Committee on Vital and Health Statistics of the Department of Health and Human Services. The Harris Interactive survey found that 48% of US adults say the benefits to patients and society of a patient EMR system outweigh risks to privacy. On the other hand, 47% of respondents said the risks outweigh the expected benefits. Four percent were undecided.

AAHomecare Sets Advocacy Priorities
The American Association for Homecare’s 2005 goals include:

• Protect HME and home health from further cuts in any legislation passed during 2005.
• Counter competitive bidding in light of recent reimbursement cuts, and expand the focus on the CMS Program Advisory Oversight Committee (PAOC) on competitive bidding.
• Protect the dispensing fee amount of $57 per monthly supply for inhalation drug therapies.
• Maintain the market basket increase and rural add-on for home health services and oppose co-payments for home health.
• Change the exclusionary rule, which compares Medicare and private charges and could exclude from Medicare providers whose charges are considered excessive based on that comparison.
• Preserve current reimbursement for stationary oxygen systems in light of efforts to move to a modality-specific payment model.

AAHomecare will tackle additional issues and challenges as they emerge. Work in the area of home health will also focus on preserving the integrity of the home health benefit by raising awareness about home care with MedPAC, preserving home health benefits in Medicaid, and creating opportunities in the areas of pay for performance and telehealth. During the year, participation from home care providers and manufacturers will be critical.

Utah and Florida Medicaid Models
Two new Medicaid reform models bear watching, one advocated by the governor of Florida and the other presided over by the new Secretary of Health and Human Services when he was governor of Utah.

In Florida, Governor Jeb Bush is advocating privatization of Medicaid. The Medicaid plan favored by Governor Bush may have an impact on HME providers in Florida, according to Brian Seeley, president of Seeley Medical and president of the Florida Association of Medical Equipment Services (FAMES). “Because the growth in Medicaid spending has been happening very quickly during the last few years, a change in the state government’s approach is inevitable,” says Seeley. “FAMES will continue to monitor this plan, and will address any issues that will have an effect on HME.”

Governor Bush’s plan involves placing Medicaid beneficiaries in managed care organizations, health plans, and provider networks, which would compete with each other for enrollees. Beneficiaries would be given a voucher, based on their individual health care risk, with which to purchase coverage from a participating plan. The plans, rather than the state and federal governments, would determine the scope of benefits. They would be expected to offer physician, emergency department, prescription drug, and laboratory test coverage, and could offer additional services. The Florida model includes catastrophic coverage in addition to the benefits offered by private plans. Nursing home care, as well as some other long-term care services, would also be unaffected.

Governor Bush’s plan will require approval from the state legislature and from federal authorities. Like other states, Florida is experiencing rapid growth in Medicaid expenditures, which account for 25% of the state’s budget.

In Utah, HHS Secretary Michael Leavitt is touting a demonstration that he championed while governor as a model for all states as they grapple with rapidly escalating Medicaid costs. The Utah experiment, the Primary Care Network, provides for coverage of more low-income people but with a reduced benefit package, including hospital emergency department and physician coverage. Inpatient hospitalization, specialty physician services, and most catastrophic costs are not covered. Medicaid beneficiaries are expected to arrange to obtain additional services from hospitals and physicians willing to provide free care. As part of this plan, all covered services will require a co-payment, and nursing home care will not be included.

Men Aged 20 to 29 Most at Risk for Sleep Apnea
According to a new study, men aged 20 to 29 with severe sleep apnea have 10 times the risk of dying from heart-related ailments than their non-sleep apnea peers, and even have a higher risk than older men with sleep apnea. The study, which was carried out by the Technion-Israel Institute of Technology, was based on 15,000 men. The researchers compared the risk of dying for men with severe sleep apnea—having at least 50 breathing stops per hour—with the general population. The findings appear in the March 2005 European Respiratory Journal. The study also showed that men aged 30 to 39 have three times the risk of dying, while those in their forties have twice the risk. But those aged 50 or older do not have a higher risk of dying than the same age group in the general population, according to the report.