Grassroots CENTRAL
CMS Speaker Says “All 10 MSAs at Once”
Will all 10 MSAs be implemented at once? The answer is yes, according to Jabal Chase, health insurance specialist for DME policy at CMS Atlanta. Chase’s appearance at Medtrade Atlanta’s Grassroots Central, presented by Home Health Care Dealer/Provider, drew an overflow crowd and sparked a few tense exchanges.

Appearing along with Colleen Carpenter, team leader, division of Medicare operations for CMS Atlanta, Chase touched on CMS’ main Web resources and the overall rationale for competitive bidding in his opening remarks. “The reason we are so excited about competitive bidding is the amount of money it is going to save the Medicare program,” said Chase. “Over the first 4 years of the program, it is estimated that competitive bidding will save $110 million the first year, and increasing to over 1.2 billion by the fourth year.”

Despite Chase’s assurances, some attendees were skeptical that competitive bidding would in fact be implemented in all 10 MSAs at once. In a panel discussion just hours after Chase’s presentation, Mark J. Higley, vice president of development for VGM, Waterloo, Iowa, expressed his doubts. “Mr Chase suggested that all 10 MSA processes would be implemented at once. Now we have all heard that in October 2007 perhaps Miami would be implemented through a phase-in process in the next 6 to 9 months,” said Higley. “I don’t necessarily question his background, but I’m not certain he had the authority to cite this as he did. But he said all 10 will kick in at once and that is quite a revelation—so we will see.”

Mark J. Higley, VP of development for VGM, questioned the accuracy of Chase’s contention that all MSAs would be implemented at once.

Another point of contention concerned the right of qualified providers to participate under competitive bidding if they agreed to meet the accepted Medicare price. Chase indicated that he agreed with this rationale, saying, “We want to have as many providers as we possibly can to make sure that all the beneficiaries continue to receive the services that they need.” However, after checking a section of the proposed rule, Chase conceded that the wording did not support his rationale.

At this point, an expert in the audience volunteered a clarification. “CMS must choose at least two suppliers in an area,” said Denise M. Fletcher, JD, an attorney with Brown & Fortunato, Amarillo, Tex. “CMS has a formula where they are going to figure out what the demand is and they will choose the suppliers to meet that demand. They will take the single payment amount of that median bid, but if you are not one of the suppliers that they have chosen and contracted with, you may not play in competitive bidding...unless you are already providing services to a patient and are grandfathered in.”

New information was in short supply, but Chase did confirm that November 15 was a probable target for the competitive bidding final rule and the naming of the 10 MSAs. Chase, who worked for a DME company and a home health agency prior to joining CMS, urged providers to make their gripes known during official comment periods. “The proposed rule for competitive bidding had more than 5,500 comments,” said Chase, “but I’m sure there were more than 5,500 people who had something to say.”

On accreditation, Chase reiterated that in 2007 all providers in the first 10 MSAs must be accredited to participate. In 2009, CMS will start with another 80 MSAs and providers in those 80 MSAs must be accredited by 2009. “There is no more information as to what year or when the next rollout will be for the next MSAs,” Chase added. — G. Thompson

Mixon Collects aahomecare humanitarian Award, Blasts OIG Report
Mal Mixon, Invacare’s longtime chairman and CEO, collected the Humanitarian of the Year award at this year’s AAHomecare Humanitarian Dinner, then offered a frank assessment of the industry’s trials and triumphs. “Last Thursday night the OIG [Office of Inspector General] came out with their biased, flawed, and stupid study,” said Mixon.

While a whole host of issues must still be addressed with the OIG report, Mixon praised the efforts of the Van G. Miller (VGM) Group, Waterloo, Iowa, for their massive efforts to contact Senator Charles Grassley (R-Iowa) and help take the 13-month OIG oxygen cap proposal off the table. Mixon told of his own efforts to ask Sen George Voinovich (R-Ohio) to contact Grassley directly and express the industry’s concerns. According to Mixon, Voinovich assured him that “Senator Grassley told him not to worry…that the cap on oxygen was removed from consideration as a savings offset in the Doc Fix bill.” To view the OIG report, go to http://oig.hhs.gov/oei/reports/oei-09-04-00420.pdf

In concluding his remarks, Mixon warned of battles to come while expressing his optimism for the future. “We are the answer to reducing health care costs and somehow we need to translate that to where the rubber meets the road,” said Mixon. “Despite the government assault, our society is going to recognize that home care is the solution to reining in health care costs.”

As for the award, AAHomecare chairman Tom Ryan said they selected Mixon due to his continuing support for humanitarian efforts for home care, and his service as an advocate of strong home care policy. Specifically, Ryan mentioned the key role Invacare played during the House-Senate conference on the Deficit Reduction Act of 2005, where Invacare helped to prevent greater damage to the home oxygen benefit.

Home health patient organizations (including those that serve the oxygen/respiratory and rehab communities) will receive the funds raised this year. Over the past year, AAHomecare has begun to work more closely with patients’ organizations to help raise awareness about common concerns and issues.

Revised Power Mobility LCD: Down-coding Out, Implementation Delayed
Efforts by the National Coalition for Assistive and Rehab Technology (NCART) to alter the August 15, 2006, local coverage determination (LCD) for power mobility devices (PMDs) paid off as Rita Hostak, president of the NCART, presented the organization’s regulatory and legislative update at Medtrade. The LCD revisions came through in an e-mail while Hostak presented the update. With the help of attendees, Hostak was able to dissect the revised LCD and report that the automatic “downcoding” to Group I power wheelchairs, if the patient did not meet coverage for a Group II or higher chair, was eliminated. Attendees breathed a sigh of relief with the announcement. “The LCD that came out in August was basically down-coding those beneficiaries who would have qualified previously for a group 2 chair into a group 1 chair,” explained Sharon Hildebrandt, NCART executive director. “For those beneficiaries who would have qualified for a group 3 chair, some of those could have been downcoded into a group 2 or a group 1.”

Despite the good news, NCART would still like to see further modifications to the LCD. These changes would come in the form of revising the qualifications for a group 3 chair, specifically the portion that states patients must be unable to do an independent standing pivot transfer. “That is problematical for certain patients with ALS and multiple sclerosis who may be able to do some kind of transfer but not really be able to do it independently,” Hildebrandt said. “We’re concerned that patients who should qualify for a group 3 chair will not qualify based on that language.”

NCART is concerned with this language because the organization focuses on beneficiaries who need class 3 chairs. While the most recently issued LCD was final, NCART is attempting to obtain further revisions. “Right now, we are working with the medical directors to try to get this clarified a little more,” Hildebrandt said.

In addition to the above-mentioned revisions, CMS has posted information on its Web site that indicated the delay of the new codes and LCD until November 15, 2006, and further stated that the fee schedules for the new PMD codes “should be available in the near future.”

AAHomecare Update: New President and CEO, Senate Companion to HR 3559 Top the Bill
At this year’s AAHomecare Update, Medtrade Atlanta, an emotional Tom Ryan told attendees that HR 3559, the House bill to alter competitive bidding for the better, finally has a Senate companion bill. According to AAHomecare legislative associate Stacey R. Harms, the bill (S 3920) from Senators Orrin Hatch (R-Utah) and Kent Conrad (D-ND) is virtually identical to Hobson-Tanner. At press time, the text of the bill had not yet been posted on the Internet. Meanwhile, HR 3559 is up to 145 cosponsors.

HR 3559 and S 3920 build in provisions to protect small providers. They would also require CMS to publish a report on the “comparability” of MSAs selected for competitive bidding to those where the competitive bidding demonstration projects were conducted. Perhaps most important, the bills would allow qualified willing providers to participate in competitive bidding if they were willing to meet the price set by Medicare.

Ryan urged providers to build on this success by urging members of Congress to cosponsor this bill and HR 5513, the Home Oxygen Patient Protection Act, which also has a Senate companion. “What we want in this next 4 weeks during the 109th session of Congress is no further erosion of the 36-month oxygen cap. That is our job. We must be left alone and we can’t have any more cuts,” said Ryan. “CMS continues to cut us on the DRA and they are looking to cut us further. We’ve had FEHBP cuts, and all these things have come since competitive bidding—and we haven’t even started competitive bidding yet. On Hobson Tanner, we have 145 cosponsors in the House and a companion bill in the Senate.”