Budget Bill Signed by Bush
In a blow to providers and home care patients, President Bush signed S 1932, the Deficit Reduction Act or DRA, which in-cludes several provisions that would make extensive changes related to home oxygen and capped rental policy—and freeze home health reimbursement for 2006. The signing came after narrow approval from the House, with an official tally of 216 to 214. Although four Republicans who had originally supported the bill changed their votes to “no,” the efforts of the home care community could not change the outcome. After changing his vote, Representative Jim Ramstad from Minnesota was quoted in a MAMES news bulletin as saying, “After listening to hundreds of Minnesotans and reading the analysis from the nonpartisan Congressional Budget Office, I voted with my conscience against a bill that disproportionately hurts vulnerable children, people with disabilities, the elderly, and the poorest of the poor. Congress must reduce the deficit, but not on the backs of the least amongst us,” said Ramstad. “Congress should adopt the Senate reconciliation bill that reduces the deficit by a similar dollar amount but in a fair and balanced way.” The home care community argued that the bill would be a disruption for seniors because of the mandate that requires transfer of title to Medicare patients for certain DME items after a 13-month rental. AAHomecare says that shifting the responsibility for maintaining complex medical equipment from providers to the elderly or disabled Medicare beneficiaries is unfair and potentially dangerous, and it is also a burden to seniors because servicing the equipment that is sold will become their responsibility. Proponents of the bill argue that it will save Medicare money by allowing beneficiaries to own the equip-ment rather than continually renting it. While the outcome of the vote is disappointing for home care supporters, the intensity of the industry’s grassroots efforts were noteworthy. Organizations teaming up with beneficiaries made a strong impact and directly contributed to influencing the votes of Representatives. With the loss behind them, home care advocates are putting their efforts into working with members of Congress to fix the negative provisions affecting home care, and toward gaining additional cosponsors to the Hobson-Tanner Bill. Some members of Congress have already offered to help fix the negative provisions of S 1932. |
President’s 2007 Budget: “Devastating Impact,” Say Experts
The President’s proposed 2007 budget, including some $36 billion in reductions to Medicare and more than $1.5 billion to Medicaid over 5 years, has caused worry among home care advocates. The budget includes a proposal to force transfer of ownership of medical oxygen equipment to Medicare beneficiaries after 13 months, a freeze on home health reimbursement, and elimination of the ability to purchase power wheelchairs in the first month.
Tim Pontius
The proposed limit of 13 months on the oxygen rental period would worsen the recent 36-month cap on medical oxygen that was included in the Deficit Reduction Act (S 1932), which Presi-dent Bush recently signed into law. “The provision to cap oxygen at 13 months instead of 36 months (as it now is in the recently signed Reconciliation Bill) is a quantum leap in the amount of savings it will generate, but it will—have no doubt—have devastating impact on the ability for providers to continue servicing Medicare beneficiaries,” said Tim Pontius, president of Young Medical and Toledo IV Care, Toledo, Ohio, and past chairman of AAHomecare.
Describing the influence that the 13-month rental payments would have on beneficiaries, a statement from Invacare, Elyria, Ohio, stated, “Virtually every beneficiary requiring home oxygen to sustain life will suffer dramatic benefit reduction because Medicare beneficiaries are on home oxygen therapy for an average of 26 months. Once ownership of the equipment transfers to the beneficiary, the home oxygen provider will no longer have a relationship with the beneficiary. The beneficiary will then be responsible for obtaining necessary services to ensure the equipment continues to operate/function properly, that the oxygen purity levels are appropriate, that regular maintenance is performed, and that the beneficiary has the necessary accessories/supplies such as cannulas and tubing.”
Another key provision would eliminate the ability to purchase wheelchairs in the first month, causing power mobility to fall into the rent-to-purchase model. If adopted, it would also hit the industry hard. “In essence, the suppliers and providers throughout the country will be asked to subsidize the Medicare program by buying this very costly technology and paying for it up front, and hope they break even over the following 13 months,” said Pontius. “Not even an option for the small independents or the nationals, I would say.” This provision is furthermore worrisome due to the fact that more than 95% of wheelchairs are purchased in the first month, said Seth Johnson, chair of AAHomecare’s Rehab and Assistive Technology Council and the vice president of government affairs for Pride Mobility, Exeter, Pa.
Ultimately, it is the decision of Congress to pass provisions from the budget proposal, and the additional changes proposed by the President for Medicare may be very difficult.
John Gallagher
“The only bright spot is that there has not been a budget passed during an election year since 1990,” said John Gallagher, vice president government relations for the Van G. Miller (VGM) Group, Waterloo, Iowa. “The feedback from members of Congress from both sides has been tepid at best, with no stomach—particularly from the Republican side—to take on Medicare again with cuts.”
Slim chance of succeeding or not, home care advocates are not taking any chances. “We have to be out talking to members of Congress about what it is that HME does and that we are a low-cost provider and get the beneficiaries involved because obviously oxygen is an issue that motivates beneficiaries,” said Gallagher. “What we have to do is tie that together with HR 3559 so that this budget doesn’t see the light of day with the cuts to DME this year or next year.”
Support for Hobson-Tanner Bill Grows
New cosponsors of the Hobson-Tanner bill have been added to the official list of 74. Introduced on July 28, 2005, by Reps David L. Hobson (R-Ohio) and John S. Tanner (D-Tenn), the Medicare Durable Medical Equipment Access Act of 2005 would remedy many competitive bidding provisions.
The new cosponsors include:
Medtrade Partners with Leading Rehab Organization
VNU Expositions, producer of the Medtrade Conference and Exposition, has formed a partnership with the National Registry of Rehabilitation Technology Suppliers to manage the rehabilitation educational track for Medtrade 2006. The partnership will provide educational programming for rehabilitation providers in the home health care industry for Med-trade 2006, scheduled for September 19 to 21 at the Georgia World Congress Center in Atlanta. The partnership will allow Medtrade attendees to receive continuing education credits for several of the rehabilitation track sessions that will be offered at the 2006 conference and will ensure the track directly speaks to the most current issues facing rehabilitation professionals. “We are confident that through NRRTS’ knowledge of the rehab industry, the rehab track at Medtrade 2006 will directly target the needs of rehab professionals, providing them with the best possible educational experience,” said Art Ellis, group vice president for VNU Expositions.
More Than 100,000 in Pilot Medicare Health Support Programs
More than 100,000 Medicare beneficiaries are now participating in the voluntary Medicare Health Support programs designed to reduce health risks and improve the quality of life for chronically ill patients, CMS recently announced. “With more than 100,000 people with Medicare already participating, we expect to learn about how we can support the best possible quality of care for our beneficiaries with chronic conditions,” said CMS Administrator Mark B. McClellan, MD, PhD.
Commonly, beneficiaries who live with multiple chronic conditions have heavy self-care burdens and experience poor health outcomes, increased costs, and diminished quality of life, despite the best efforts of their physicians and other health care professionals. There is evidence that self-care support, education, and assistance in coordinating care for people with these conditions can be effective in improving clinical outcomes, reducing their health care costs, and improving participant and provider satisfaction.
Medicare Health Support connects program participants with specially trained health professionals. The eight pilot programs offer guidance and other support to help these chronically ill beneficiaries manage their health, adhere to their physicians’ plans of care, and reduce their health risks. The organizations’ interventions include personalized care plans, the use of biometric monitoring devices (for weight, blood pressure, and pulse), 24-hour telephonic nurse access, and group education and support sessions.
Congress created the Medicare Health Support programs as part of the Medicare Prescription Drug, Improvement, and Modernization Act in December 2003. The pilots were announced in December 2004.
“Medicare Health Support is an innovative approach to care that represents a key priority for the future of Medicare,” said McClellan. “We are committed to improving the quality of care and quality of life for chronically ill beneficiaries, leading to fewer complications and overall health care cost savings.”
NSCAC Appoints New Committee
The National Supplier Clearinghouse Advisory Committee (NSCAC), an organization comprised of individuals that are representing their respective DMERC Advisory Committees in all four regions in the US, has elected its 2005-2006 executive committee members. The following NSCAC members were elected to the 2005-2006 Executive Committee Members: Chairperson, Tom Heinrich, McKesson Medical-Surgical Supply, Minnesota; Vice Chairperson, Gary Morse, Roberts Home Medical, Maryland; Secretary, Joan Cross, C & C Home Respiratory Inc, Florida; and Treasurer, Herb Langsam, Medicare Recovery Inc, Oklahoma; and the Past Chairperson, Wade Hendrickson, Hendrickson Health, Iowa.
CMS MAC Contract Draws Complaint
CMS has granted new contracts for four specialty contractors who will be responsible for handling the administration of Medicare claims from suppliers, which have a combined potential value of $542 million. According to a February 4, 2006, report in the Grand Forks Herald, a $97 million contract to Noridian Administrative Services to handle billing and customer service for Region D, has drawn a complaint from Cigna Government Systems, the company that previously handled the claims. According to the report, Noridian’s contract has been put on hold. DP
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