Senator Crapo Leads Effort to Prevent Home Oxygen Cuts
Sen Mike Crapo (R-Idaho) is once again getting behind the home care community—this time to engage in a struggle to prevent home oxygen from being a target in the Senate budget bill. In budget reconciliation legislation that was recently signed into law by the President, oxygen rental was capped at 36 months, but this figure may potentially be exacerbated by language in the President’s proposed budget that calls for the oxygen cap at 13 months. “The move to the 36th month is worrisome due to numerous uncertainties in the oxygen program; a further move to the 13th month would only add to the confusion,” says Sen Crapo. “No studies have been performed seeking to determine beneficiary impact; it is unclear how system upgrades, service, or maintenance will be provided and paid for; and no differentiation between portable and stationary oxygen systems has been made. Along with other Senators, I lobbied Budget Chairman Gregg not to include the cuts before fully understanding the impact of the reduction in the Deficit Reduction Act on beneficiaries.”

Sen Mike Crapo (R-Idaho)

Due to the uncertainty of the impact on beneficiaries, Sen Crapo lobbied to include language in the budget report that aims to create policy that is both fiscally and medically sound. The language that he successfully lobbied to include in the budget report states:

“The Committee notes that Medicare program’s mounting insolvency in coming years will demand increased attention towards reducing the rate of growth in payments to providers; however, while this attention is warranted, the Committee urges that increased consideration also be given towards the impact on beneficiaries under any such provider payment reduction.”

Home care advocates are right alongside the Senator’s efforts to push for prevention of further oxygen cuts. “We greatly appreciate Senator Crapo’s leadership on the home oxygen therapy issue during budget discussions,” says Michael Reinemer, vice president for communications and policy, AAHomecare.

While Crapo is hesitant to speculate on the odds that the budget will pass with the oxygen cuts included, he says, “I will remain vigilant that the home oxygen cuts remain out of the budget.”

Rep Bill Thomas Set to Retire
Rep Bill Thomas (R-Calif), widely regarded as an enemy of the HME industry, recently announced his retirement, declaring that he will not seek reelection in November. But his departure as chairman of the House Ways and Means Committee does not mean that the industry can quite yet write him off as harmless. With about 9 months before his term ends, home care advocates need to carefully watch Thomas’ moves. “Rep Bill Thomas (R-Calif) is still in Congress for another 9 months and may still try to sneak in a 13-month cap on oxygen—probably after the election when they still don’t have a budget.... We’ve got to get the message out as an industry: No more Medicare cuts,” says John Gallagher, vice president of government relations for The Van G. Miller (VGM) Group, Waterloo, Iowa. Thomas is believed by some in the industry to have been behind the insertion of the 13-month oxygen cap into the President’s 2007 budget proposal. He also played a part in HME cuts included in the Medicare Modernization Act, which gave birth to competitive bidding, and he was also instrumental in inserting a provision to cap oxygen rental at 36 months into the Deficit Reduction Act.

Candidates Surface for Next Ways and Means Chairman
With Bill Thomas’ recent retirement announcement, potential candidates for the chairman of the Ways and Means Committee have emerged, with three leading contenders likely to fill the position. According to John Gallagher, director of government relations for the VGM Group, likely candidates are:

• Rep Clay Shaw (R-Fla)
Clay sits as current chairman of the Social Security Sub-Committee.
“He of the three would probably be less likely to embrace our industry,” said Gallagher at his presentation at Medtrade Spring.

• Rep Nancy Johnson (R-Conn)
Johnson is the current chairwoman of the Health Subcommittee. “Members of NEMED have done a great job meeting with her and beginning dialogue and education,” says Gallagher. “She of the three would probably be best for our industry.”

• Rep Jim McCrery (R-La)
McCrery sits on the Ways and Means Committee and has no prior elected office experience.

Hobson-Tanner Cosponsor List Continues to Grow
New cosponsors for the Hobson-Tanner bill, HR 3559, have been added to bring the official list to 92. The recent additions include:
· Rep Marion Berry (D-Ark)
· Rep Diana DeGette
(D-Colo)
· Rep Tim Holden (D-Pa)
· Rep William Jenkins (R-Tenn)
· Rep Mike McIntyre (D-NC)
· Rep Tom Price (R-Ga)
· Rep Bill Shuster (R-Pa)
· Rep Adam Smith (D-Wash)

Bill Would Carve Rehab Out of Competitive Bidding
Rep Ron Lewis (R-Ky) has introduced HR 4994, a bill that would amend title XVIII of the Social Security Act to exempt complex rehab products and assistive technology products from competitive bidding. Lewis told Dealer/Provider that “Certain assistive products and services are so technical and specialized in nature that competitive bidding would significantly jeopardize their quality and effectiveness. This legislation is necessary to ensure that Americans who require these products and services do not suffer as a result of an otherwise beneficial law.” Also cited as the Medicare Access to Complex Rehabilitation and Assistive Technology Act of 2006, the bill describes complex rehabilitation products and assistive technology products as “adaptive seating, positioning, and mobility devices and speech generating devices that are evaluated, fitted, configured, adjusted, or programmed to meet the specific and unique needs of an individual with a primary diagnosis resulting from injury or trauma or which is neuromuscular in nature.” The language goes on to state that a primary diagnosis includes “spinal cord injury, traumatic brain injury, cerebral palsy, muscular dystrophy, spinal muscular atrophy, spina bifida, amyotrophic lateral sclerosis, multiple sclerosis, or any other disease or disability identified by the Secretary as requiring the use of such devices.”

OIG: CMS’ Part B Drug Pricing Doesn’t Add Up
A report issued by the Office of Inspector General (OIG) exposes a CMS calculation flaw that deals with payments for Part B drugs that resulted in unnecessary Medicare spending and also undercut reimbursement funds to providers. The flaw deals with the method CMS uses to calculate a volume-weighted average sales price (ASP) for a Healthcare Common Procedure Coding System (HCPCS) code. According to the report, “46% of HCPCS codes had a reimbursement amount that was higher than it should have been, resulting in an estimated $115 million loss to Medicare in 2005. For 13% of HCPCS codes, CMS’s reimbursement amount was lower than it should have been, representing an estimated $5 million loss to providers in 2005. For the remaining 41% of HCPCS codes, there was no difference between the reimbursement amount calculated by CMS and the reimbursement amount calculated by OIG.” A reply letter from Mark B. McClellan, MD, PhD, CMS administrator, stated that CMS is working toward refinements in the payment methodology and is already addressing the subject matter of the OIG report.

CMS Issues Medicare Phone Scam Warning
CMS recently released information warning seniors and people with disabilities to be aware of a scheme that asks Medicare beneficiaries for money and checking account information to help them enroll in a Medicare Prescription Drug Plan.

This scheme is called the “$299 Ring” for the typical amount of money Medicare beneficiaries are talked into withdrawing from their checking accounts to pay for a nonexistent prescription drug plan. Providers may wish to inform beneficiaries that they can report these cases to their local law enforcement agencies or (877) 772-3379. DP