New Senate Bill Gives Hope for Repeal of DRA Oxygen Policy By introducing S 3814, a bill that would repeal the provisions passed in the Deficit Reduction Act (DRA) that force Medicare oxygen patients to assume ownership of oxygen equipment after 36 months, Sen Pat Roberts (R-Kan) has provided hope for the home care community and oxygen patients. “With the transfer of ownership of the medical oxygen equipment to the patient, important preventive maintenance mandated by manufacturers and currently performed by oxygen providers shifts to the patient. This increases the risk of patients self-medicating or not getting enough oxygen due to equipment malfunction,” Roberts said. “This is an unreasonable burden and worry for seniors who are very ill.”
Along with Roberts, four cosponsors, Senators Mike DeWine (R-Ohio), Barbara Mikulski (D-Md), Jack Reed (D-RI), and George Voinovich (R-Ohio), introduced the bill, which would amend part B of title XVIII of the Social Security Act to restore the Medicare policy of oxygen ownership to its prior status before the introduction of the DRA.
Backed by AAHomecare, the bill is a companion to Congressman John Schwarz’s (R-Mich) bill, HR 5513. “The two bills provide excellent tools for reversing the oxygen policy changes passed in the DRA, which raise numerous patient-safety concerns,” AAHomecare said in a recently released statement. “Those changes were vigorously opposed by the American Association for Homecare, the American Lung Association, and other patient and home care organizations.”
Brevity Reigns, Questions Remain as CMS Releases Final Accreditation Standards As HME providers digest CMS’ 14 pages of accreditation standards, it becomes clear that what is absent is just as significant as what is there. After 5,600 comments from the industry, CMS heard the complaints, but some experts say they might have been wise to address more questions and publish more pages. “Overall, the pendulum swung. CMS was way overprescriptive, and they realized it,” says Mary Ellen Conway, president of Capital Healthcare Group LLC, a consulting group in Washington, DC. “Now it’s swung the other way and I have a million questions. And I don’t know how we are going to pose these questions because there is no comment period.”
One of the many overlooked subjects is infection control. “There is nothing in there about infection control, but you would never survey an organization and not look at their infection control standards and guidelines,” says Conway. “Now let’s pretend you are JCAHO and you sit down and develop your standards and you have an entire chapter on infection control and safety. Now, a provider can choose to go with you or somebody else, but they are not going to be able to choose pieces out of that chapter—and I don’t think you should eliminate half of the chapter.”
Many of the respected accreditation organizations now address various topics not mentioned in the final standards. “There’s nothing in there about benchmarking, health screenings, or criminal background checks. And those are all pieces that are always in an accreditation program,” says Conway. “They went so minimal on this, which is good in many ways—but does that leave it open for Joe Blow’s accreditation company to open a company that surveys only on those 14 pages—and not everything else? And now do you get fly-by-night accreditation?”
Of course, much of what got left behind is good news for providers. For example, a proposed regulation under support surfaces required providers to involve enteral-stoma nurses when appropriate. However, providers pointed out that with only about 4,000 such nurses in the whole country, that would not be practical. CMS agreed. AAHomecare listed these additional positive changes to the final standards:
• eliminating the requirement to be open for 40 hours per week and replacing it with a requirement to maintain posted business hours;
• clarifying requirements for performance management to allow suppliers flexibility in determining indicators related to products and services; and
• consolidating and incorporating certain product-specific standards into the general product-specific service standards, and reducing the number of standards from 15 to three.
Just prior to releasing the standards, CMS released its final rule regarding competitive bidding requirements for suppliers to be accredited by independent accrediting organizations. An AAHomecare fact sheet on the subject illustrates the following:
• CMS hopes to minimize burden and duplication of effort for suppliers that have already been accredited, Medicare-certified, and/or licensed under state law, by taking into consideration any previous accreditation, certification, and/or licensure findings that indicate that quality standards are being met at the time the accreditation organization surveys the supplier. CMS does not have the statutory authority to exempt any supplier that furnishes DME, prosthetic devices, prosthetics, and/or orthotics under Part B from meeting the quality standards and accreditation requirements.
• CMS is phasing in the requirement for suppliers to become accredited consistent with the statutory phase-in of competitive bidding. Suppliers in the first phase of competitive bidding must be accredited in early 2007. Those in the second phase must be accredited by the winter of 2007. The statute does not establish further dates for implementation, but future guidances will be issued.
• CMS is requesting accreditation organizations to prioritize their surveys based on the statutory requirements for phasing-in implementation of the Medicare DMEPOS Competitive Bid-ding Program. The first priority will be to accredit suppliers in the MSAs for 2007. CMS expects to approve several accreditation organizations to meet the bidding dates. For additional coverage of final accreditation standards, see page 80.
Medicare Proposes Rule to Bring Change to Oxygen Reimbursement CMS has left out the input of the home care community, pulmonary physicians, and patients in the issuance of a proposed rule affecting Medicare oxygen policy. The proposed rule, 1304-P, would set new classification and monthly payment amounts for home oxygen therapy technologies. “[The proposed rule] effectively revamps the oxygen classification system by splitting stationary and portable oxygen contents into two separate payment classes,” said Tom Pontzius, president of Nationwide Respiratory, Waterloo, Iowa. “The proposal calls for a third payment class for new technologies, such as portable concentrators and home transfilling systems.”
CMS’ proposed new national monthly rental rates are as follows:
Home care industry supporters are urging support of HR 5513, a bill that would eliminate the proposed rule and bring Medicare treatment of home oxygen back to a continuous rental model.
New Senate Bill Gives Hope for Repeal of DRA Oxygen Policy 
One of the many overlooked subjects is infection control. “There is nothing in there about infection control, but you would never survey an organization and not look at their infection control standards and guidelines,” says Conway. “Now let’s pretend you are JCAHO and you sit down and develop your standards and you have an entire chapter on infection control and safety. Now, a provider can choose to go with you or somebody else, but they are not going to be able to choose pieces out of that chapter—and I don’t think you should eliminate half of the chapter.” 
Medicare Proposes Rule to Bring Change to Oxygen Reimbursement 
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