CMS released a final rule confirming payment and documentation policies established in the interim final rule (IFR), with little change aside from giving physicians and treating practitioners 45 days, rather than 30 days, after the date of the face-to-face examination to provide pertinent parts of the medical record to DME suppliers. The extension is positive news for home care advocates, but the rule was not met without some dissatisfaction because the industry still needs more information regarding exactly what documentation is essential for reimbursement of power mobility claims.

Beginning April 1, 2006, for claims submitted to the DMERCs, providers should follow the requirements outlined in the IFR until implementation of the Power Mobility Device (PMD) Final Rule on June 5, 2006. Specifically, the CMS Fact Sheet on the Final Rule states:

. Written Prescription: The physician or treating practitioner must submit a written prescription for the PMD to the supplier. This prescription must be received by the supplier within 45 days after the face-to-face examination, or in the case of a recently hospitalized beneficiary, within 45 days after the date of discharge from the hospital.

. Supporting Documentation: The physician or treating practitioner who performed the face-to-face examination must submit to the DME supplier the written prescription accompanied by supporting documentation of the beneficiary.s need for the PMD in the home. This supporting documentation will include pertinent parts of the medical record that clearly support the medical necessity for the PMD in the beneficiary.s home, which may include the history, physical examination, diagnostic tests, summary of findings, diagnoses, and treatment plans. It may also include information from other examinations, as well as relevant reports from other consultants and practitioners.

Hobson-Tanner Nears 100 Cosponsors
New cosponsors for the Hobson-Tanner bill, HR 3559, have been added to bring the official list to 95. 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. Recent additions include the representatives pictured at right.

Selective Acquisition MSAs Predicted
Home care providers who are concerned about the effects of cometitive bidding are understandably curious about which cities will be selected as the first ten metropolitan statistical areas (MSAs). While no answer from CMS has been announced, John Gallagher, vice president, government relations, VGM Group, Waterloo, Iowa, thinks the cities may come from among the following locales: Philadelphia; Dallas; Detroit; Atlanta; Phoenix; Seattle; Minneapolis; St Louis; Tampa, Fla; Denver; Portland, Ore; San Jose, Calif; Columbus, Ohio; Providence, RI; Indianapolis; Milwaukee; Charlotte, NC; Nashville, Tenn; Birmingham, Ala; and Las Vegas. Likely locations, Gallagher says, are those that are not large cites, but those that are more self-contained. .What the government is saying is they are not going to big cities where they are going to fail,. says Gallagher. .CMS also said that they would not go to multiple locations in one state. They also don.t want to go to areas that have overlap with some states,. he says.

Nebulizer Policy Revisions Mean More Cuts
Designed to revise the current nebulizer coverage policy, a recently issued draft local coverage determination (LCD) proposes changes that would cause significant cuts for nebulizer medications. The first of those changes will reduce levalbuterol reimbursement to the allowable established for albuterol. .This proposed revision will eliminate the ability of suppliers to provide Xopenex. to Medicare beneficiaries unless the supplier is willing to do so at a loss,. said Lisa K. Smith, JD, attorney with the Health Care Group of Brown & Fortunato PC, Amarillo, Tex, in a recent Dealer/Provider Midweek Analysis article.

The second proposed change states that payment for DuoNeb. will be based on the allowance for separate unit dose vials of albuterol and ipratropium. .Suppliers will not be able to provide DuoNeb to Medicare beneficiaries unless the supplier is willing to be reimbursed for less than its cost,. says Smith. .The third proposed change eliminates coverage for a significant number of nebulizer drugs that have historically been covered by Medicare, and for formoterol..

According to the Durable Medical Equipment Program Safeguard Contractors (DME PSC), the third proposed change states: Coverage for the following nebulizer drugs is eliminated because there is inadequate support in the medical literature for administration using a DME nebulizer. These drugs are amikacin, atropine, beclomethasone, betamethasone, bitolterol, dexamethasone, flunisolide, formoterol, gentamicin, glycopyrrolate, terbutaline, and triamcinolone. Coverage will therefore be limited to these drugs: acetylcysteine, albuterol, budesonide, cromolyn, dornase alpha, iloprost, ipratropium, isoetharine, isoproterenol, levalbuterol, metaproterenol, pentamidine, and tobramycin. The fourth proposed change defines maximum milligrams/month for budesonide.

Home Care Spending Small in the Scheme of Medicare Budget
HME expenditures and home health expenses in Medicare over the past decade equal small portions of the Medicare budget, according to figures from CMS National Health Expenditure Data. Demand for home care has increased along with the medical needs of a growing population of older Americans, but spending for home care remains a minor portion of Medicare spending. MAC Transition Stalled

The CMS changeover from DMERCs to Medicare Administrative Contractors (MACs) has been put on hold for Regions C and D, moving the transition date from July 1 to October 1, while Regions A and B are still on schedule for the transition date of July 1. Region C and D are experiencing delays because Cigna Government Services bid on the MAC contract and, after losing the bid, filed a protest with CMS, causing a holdup until the Government Accountability Office (GAO) rules on the dispute. At press time, the deadline for the GAO decision on the protest is May 4, 2006.

Letter to Make Rounds in Budget Debate
US Senators Susan Collins (R-Me) and Russell Feingold (D-Wis) plan to send a letter of support for the home health benefit to Senate Finance Committee Chairman Charles Grassley (R-Iowa) and Max Baucus (D-Mont), the ranking Democrat on the Committee, according to the American Association for Homecare. Senators Collins and Feingold are asking home health agencies to urge their US Senators to sign onto the letter, which will be circulated as Congress debates the 2007 budget. In its recently passed fiscal year 2007 budget resolution, the Senate did not include any home care cuts. Senators Collins and Feingold are urging their colleagues to stick to this Senate position. DP