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    01/11/2017
    HME News Staff

    WASHINGTON – More than 11.5 million people nationwide were signed up for Health Insurance Marketplace coverage as of Dec. 24, 2016, according to a new report from the Department of Health and Human Services.

    That’s an increase of 286,000 compared to the same period the previous year.

    Additionally, more than 700,000 residents of New York and Minnesota also signed up through the Basic Health Programs offered by those states, bringing the total to 12.2 million enrolled.

    More than 8.7 million people signed up for coverage through healthcare.gov for 2017. They included:

    ·      8 million female and 4 million males;

    ·      9 million white, 584,000 African-American, 882,000 Latinos and 573,000 Asian consumers; and

    ·      6 million rural Americans.

    “Nationwide demand for health coverage is higher than ever, as Americans prove again that Marketplace coverage is vital to them and their families,” said HHS Secretary Sylvia Burwell.


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    01/12/2017
    HME News Staff

    WASHINGTON – AAHomecare’s State Leaders Council has formed a work group to explore ways to address competitive bid pricing for Medicaid.

    The 21st Century Cures Act, which passed in December, contained a provision that limits the federal portion of Medicaid reimbursement to Medicare’s bid pricing for DMEPOS starting in 2018.

    The work group will assess what level of flexibility states have in setting Medicaid rates, and will develop approaches to educate state Medicaid directors about their options under the new law.

    
“We’re excited to expand the focus of AAHomecare’s partnership with our local HME associations to tackle increasing state issues facing our members as a result of the changes mandated in the Cures Act that affect Medicaid reimbursement,” said Kam Yuricich, who chairs the work group and the State Leaders Council, and is executive director of the Ohio Association of Medical Equipment Services and Great Lakes Home Medical Services Association.  


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    01/13/2017
    HME News Staff

    WASHINGTON – Industry stakeholders were still waiting for word from CMS at press time on Friday on how the agency plans to retroactively delay a second round of reimbursement cuts in non-competitive bidding areas.

    The recently passed 21st Century Cures Act included a provision to retroactively delay the cuts from July 1, 2016, to Jan. 1, 2017.

    When CMS had to delay its plans to apply bid pricing to accessories for complex power wheelchairs at the last-minute per a bill signed into law on Dec. 28, the agency didn’t come out with guidance until the third week of January, points out Cara Bachenheimer, senior vice president of government relations for Invacare.

    Stakeholders have argued that CMS should bear the responsibility of re-processing the claims over the six-month period.

    Drive buys U.K. bed manufacturer

    PORT WASHINGTON, N.Y. – Drive DeVilbiss Healthcare has already kicked off 2017 with an acquisition.

    The company announced Jan. 9 that it has acquired Sidhil Group, a U.K. manufacturer of hospital and long-term care beds, pressure prevention products and a range of aids to daily living for the homecare, acute care and long-term care markets in the U.K. and throughout Europe.

    “This acquisition will expand Drive’s existing manufacturing capabilities in the U.K., while adding significant manufacturing expertise to our European platform,” said Harvey Diamond, CEO of Drive, in a press release.

    Sidhil Group has been manufacturing healthcare products in the U.K. for more than 130 years, with a focus on research and development. It currently operates from a state-of-the-art, 105,000-square-foot facility in Halifax, West Yorkshire, and has a nationwide service center network.

    For Sidhil Group, which had its start as a small, family-run business, the acquisition allows the company to bring its product line to “new markets the world over,” said Peter Siddall, chairman of the Sidhil Group, in the release.

    Drive has already made a number of acquisitions in the bed market, most recently U.K.-based Park House Healthcare in 2015.

    Terms of the deal with Sidhil Group were not disclosed.

    Obamacare enrollments outpace last year

    WASHINGTON – More than 11.5 million people nationwide were signed up for Health Insurance Marketplace coverage as of Dec. 24, 2016, according to a new report from the Department of Health and Human Services.

    That’s an increase of 286,000 compared to the same period the previous year.

    Additionally, more than 700,000 residents of New York and Minnesota also signed up through the Basic Health Programs offered by those states, bringing the total to 12.2 million enrolled.

    More than 8.7 million people signed up for coverage through healthcare.gov for 2017. They included:

    ·      8 million female and 4 million males;

    ·      9 million white, 584,000 African-American, 882,000 Latinos and 573,000 Asian consumers; and

    ·      6 million rural Americans.

    “Nationwide demand for health coverage is higher than ever, as Americans prove again that Marketplace coverage is vital to them and their families,” said HHS Secretary Sylvia Burwell.

    Work group expands focus on Medicaid issues

    WASHINGTON – AAHomecare’s State Leaders Council has formed a work group to explore ways to address competitive bid pricing for Medicaid.

    The 21st Century Cures Act, which passed in December, contained a provision that limits the federal portion of Medicaid reimbursement to Medicare’s bid pricing for DMEPOS starting in 2018.

    The work group will assess what level of flexibility states have in setting Medicaid rates, and will develop approaches to educate state Medicaid directors about their options under the new law.

    
“We’re excited to expand the focus of AAHomecare’s partnership with our local HME associations to tackle increasing state issues facing our members as a result of the changes mandated in the Cures Act that affect Medicaid reimbursement,” said Kam Yuricich, who chairs the work group and the State Leaders Council, and is executive director of the Ohio Association of Medical Equipment Services and Great Lakes Home Medical Services Association.  

    Arriva gets day in court

    WALTHAM Mass. – CMS has agreed not to terminate Arriva Medical’s mail-order contract while the provider appeals to have its license reinstated.

    An administrative law judge has required both parties to have initial briefings finished by Jan. 18. A hearing is scheduled for Feb. 8 before the Federal District Judge, stated Alere, Arriva Medicals’s parent company, in a press release. CMS revoked Arriva Medical’s billing privileges in November for allegedly submitting 211 claims for deceased patients between April 15, 2011, and April 25, 2016.

    Bill seeks payment for pharmacy services

    WASHINGTON – Sens. Chuck Grassley (R-Iowa), Bob Casey (D-Penn.) and Sherrod Brown (D-Ohio) have re-introduce a bill to help pharmacists provide healthcare services to Medicare beneficiaries in underserved areas. The Pharmacy and Medically Underserved Areas Enhancement Act, S.109, seeks to offer Medicare payment for services such as wellness screenings, immunizations and diabetes management. “Across the country and in Pennsylvania pharmacists play a critical role in helping seniors receive access to routine healthcare services like wellness checks,” said Sen. Casey in a release. “This legislation will aid those in rural communities who may not live in close proximity to the doctor but do have regular contact with their pharmacist. The National Community Pharmacists Association supports the bill. “Pharmacists are highly trained professionals and the most accessible health care providers for patients,” said NCPA CEO Douglas Hoey.The bill has 27 original co-sponsors.

    ResMed set to launch travel CPAP

    SAN DIEGO – ResMed has received clearance from the U.S. Food and Drug Administration for its AirMini, a device that the company says is “the world’s smallest continuous positive airway pressure (CPAP) device.” ResMed expects to launch the AirMini later this year. It is designed as a secondary CPAP, making it easier for users to continue their sleep therapy while traveling. “ResMed AirMini is the portable travel CPAP patients and home medical equipment providers have been waiting for, and we look forward to bringing it to market later this year,” said ResMed CEO Mick Farrell in a press release. “It fits easily in carry-on luggage—even in the seatback pocket on the plane.” Human Design Capital, which is owned by private investment firm PBM Capital, launched a portable CPAP device called the Z1 in 2013. It is sold direct to consumers.

    AASM launches platform for HME

    DARIEN, Ill. – AASM SleepTM, a telemedicine platform for board-certified sleep physicians and accredited sleep centers from the American Academy of Sleep Medicine, is now available for the HME industry. AASM SleepTM offers a secure web-based video platform to facilitate live consultations and follow-up visits between DME providers and patients, including equipment set-up and troubleshooting potential problems. “Telemedicine is changing the health care landscape by increasing connectivity between patients and health care providers, and now that convenience is available to DME providers and their at-home patients,” said Jerry Barrett, AASM executive director.

    Senators take NTSB to task

    WASHINGTON – Five U.S. senators have asked the National Transportation Safety Board to conduct a review of the implementation of sleep apnea testing for engineers for all passenger railroads. In a letter to NTSB Chairman Christopher Hart, Democratic Sens. Bob Menendez and Cory Booker of New Jersey, Chuck Schumer and Kirsten Gillibrand of New York, and Richard Blumenthal of Connecticut note that operator fatigue and sleep apnea have been cited in recent train crashes, including a fatal crash in Hoboken, N.J., last September, and is being looked at in conjunction with a recent crash in Brooklyn. "What's even more concerning than the slow progress railroads are making is an apparent growing trend of railroads pledging to implement sleep apnea testing and inward cameras only after a derailment has occurred on their system," the senators wrote in the letter.

    Inogen expects to recoup $2M

    GOLETA, Calif. – Inogen expects to recoup up to $2 million in rental revenues for the fourth quarter of 2016 as a result of a provision in the recently passed 21st Century Cures Act. The provision requires CMS to retroactively delay a second round of reimbursement cuts in non-competitive bidding areas from June 30, 2016, to Dec. 31, 2016. The company based its estimate on preliminary, unaudited financial data, it said in a press release. “We are pleased that the Cures Act reverses some reimbursement cuts in 2016 and are encouraged that it calls for a study of the impact of the competitive bidding pricing on rural areas,” said CEO Raymond Huggenberger in the release. The cuts went back into effect Jan. 1, 2017.

    Aeroflow launches petition to protect breastfeeding support

    ASHEVILLE, N.C. – Aeroflow Healthcare has created a petition to keep breastfeeding support as a women’s preventative care guideline available through the Affordable Care Act. Currently, pregnant and new mothers are covered for services like breastfeeding support, but these services are “on the chopping block,” the company states in a press release, under a new administration and a new Congress. “Replacement insurance plans may still include preventative care in bits and pieces, but the most vulnerable populations—young mothers and the children they support—will likely be the hardest hit by elimination of these guidelines,” the release states. Aeroflow’s Mom & Baby division provides lactation support, breast pumps and pumping supplies.

    PSP Homecare sees sales increase

    RANCHO CUCAMONGA, Calif. – Proto Script Pharmaceutical, doing business as PSP Homecare, has increased its sales by nearly 75% over the past year, the company announced Jan. 11. The provider has competitive bid contracts for standard mobility equipment and general home medical equipment. "I am pleased to report that during the three months ended Sept. 30, 2016, we were successful at increasing our topline sales by almost 75% over the previous year and actually turned a very small profit," said Michelle Rico, CEO and president. "As positive as this sales increase has been, we are very confident that this is only the beginning of our growth strategy taking hold and that there is much more to come."

    Save the date: Essentially Women sets fall conference

    WATERLOO, Iowa – Essentially Women has scheduled its annual education conference and trade show for Sept. 16-18 in Minneapolis. “We’re excited to bring our members and vendors to the Midwest next fall,” said Christa Miehe, president, in a press release. “Minneapolis was chosen as our destination for 2017 because it’s an equitably accessible location in the center of the country.” The three-day “Focus” conference will provide members with continuing education and training, resources to improve operational efficiencies, and networking opportunities. Registration will open in March. The VGM Group bought EW, a member services organization with more than 600 members in 1,000 locations, in late 2015. It has moved the annual conference from the spring to the fall.

    BOC elects new members

    OWINGS MILLS, Md. – The BOC board has elected its 2017 executive committee. Bradley Watson, president of Clarksville Limb + Brace + Rehab in Bowling Green, Ky., chairman; Rod Borkowski, president of Health Essentials in Calif., vice-chairman; Wayne Rosen, owner of W.R. Rosen, Inc., in South Florida, secretary; Shane Ryley, area clinic manager at Hanger Orthopedic Group in Torrance, Calif., treasurer; and Jeffrey Hedges, president of R.J. Hedges & Associates in New Florence, Pa., member-at-large. James Hewlett continues to serve as immediate past chairman. The board also named Von Homer and John Owen to the board.

    Carex light therapy lamp shines bright

    QUINCY, Mass. – Carex Health Brands’ Day-Light Classic Plus, was recognized by The Sweethome as the “best light therapy lamp,” the manufacturer announced in a recent press release. "At Carex Health Brands, we strive to deliver quality, innovative and affordable products that will help consumers live their best lives,” said Jeff Swain, vice president of marketing, retail, for Compass Health Brands. “We are absolutely thrilled that our Day-Light Classic Plus bright light therapy lamp has been recognized for just that.” The Day-Light Classic Plus can help consumers experience relief from seasonal affective disorder in 20- to 30-minute treatment sessions. The Sweethome, part of The New York Times Company, examined about 40 lamps.


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    See and feel matters, say majority of respondents to HME Newspoll
    01/20/2017
    Liz Beaulieu

    YARMOUTH, Maine – The larger trends in retail may point to the cloud, but for HME providers, it’s still all about bricks and mortar, according to a recent HME Newspoll.

    A large majority of respondents to the poll (71%) say they are focusing their retail efforts in-store, not online. That’s because, according to a large majority of respondents (78%), their customers prefer to buy HME in-store.

    “Our elderly clients still want to touch the item before they buy it,” said Kevin Jones of Travis Medical in Oklahoma. “They are also scared of identity theft.”

    Deb Swaim of Riverside Health Equipment in Illinois agrees.

    “The demographics of the customers in our location prefer to see and feel the items vs. purchasing online,” she said.

    Several respondents did make the distinction that a customer’s preference to buy in-store vs. online depends on the type of HME. And they say they’re upfront with their customers about that.

    “Familiar items or items needing no customer service are sought online,” said one respondent. “We freely tell customers that if they don’t need the services that we layer on the product (billing, set up, adjustment, teaching, etc.), then by all means save some money by buying online. They appreciate the advice and come back when they do need a service-intensive product.”

    Because a customer’s preference may depend on the product, several respondents emphasized the importance of having a presence both in-store and online.

    “We use a combination,” said one respondent. “Some people want to come in and see the product and get educated on how to use it. Others have researched and know what they want—these people are more online-oriented. Also, having online retail increases our coverage area.”

    The decision to buy in-store or online really comes down to whether or not a product needs service, respondents say. Some argue most HME—save supplies—does.

    “Yes, plenty of people buy online but they are finding out that the retailers charge more to service products purchased online,” said one respondent. “Most DME needs servicing—that is the catch.”

    Because HME providers have an increasing number of competitors from both an in-store and online perspective (think Walmart and Amazon, respectively), one of the keys to success is appropriate pricing, respondents say.

    “We have been doing retail for about nine years,” said Bob Forbes of Advantage Home Oxygen in Pennsylvania. “We’ve always looked at Internet pricing and, more importantly, Walmart pricing, and set our prices accordingly.”


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    ‘The states are going to get less money and the big question now is, how are they going to deal with that?’
    01/20/2017
    Liz Beaulieu

    WASHINTON – A directive from Congress to tie Medicaid reimbursement to Medicare reimbursement will be a tough pill to swallow for not only HME providers but also states, industry stakeholders say.

    A “pay for” in the 21st Century Cures Act stipulates that the federal government’s share of Medicaid reimbursement to states for DME be limited to Medicare payment rates, rates that have been decimated by subsequent rounds of competitive bidding.

    “The states and the DME providers are in the same boat,” said Cara Bachenheimer, senior vice president of government relations for Invacare. “The states are going to get less money and the big question now is, how are they going to deal with that?”

    The change in Medicaid reimbursement is slated for Jan. 1, 2018.

    AAHomecare convened a sub-group of its Regulatory Council recently to strategize how to best handle the change in Medicaid reimbursement. What the 15 members came away realizing: There are a lot of questions that need to be answered.

    “Like a lot of laws, it gets passed and then everyone goes, ‘How does it actually get implemented’?” said Kim Brummett, vice president of regulatory affairs for AAHomecare. “What are the states actually required to do?”

    It’s Brummett’s initial sense that the money the states get from the federal government for Medicaid isn’t tied to the Medicare fee schedule per se, but to a formula. So the big question isn’t, do they have to match the bid rates, but, how does that formula change, she says.

    Members of the sub-group are in the throes of doing research on this and other details, so they can then approach state Medicaid programs with “really good information,” Brummett said.

    “We want to be able to go to them and say, ‘This is a law, here is a legal opinion (on how to implement it),’” she said. “As opposed to them going, ‘We have to meet those competitive bidding fee schedules.’”
    The earlier stakeholders start having conversations with state Medicaid programs, the better, Bachenheimer says.

    “Getting in with state officials to talk through this is key, so that maybe we can figure out ways to make whole the payment amount in some way,” she said. “States don’t have a pot of gold to pour into it, so it’s not going to be easy.”


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    01/20/2017
    HME News Staff

    WASHINGTON – CMS classified “therapeutic” continuous glucose monitoring systems as durable medical equipment in a Jan. 12 ruling.

    CMS says CGMs are considered therapeutic and meet the definition of DME if:

    ·      They are approved by the FDA for use in place of a blood glucose monitor for making diabetes treatment decisions (for example, changes in diet and insulin dosage);

    ·      They are generally not useful to the individual in the absence of an illness or injury;

    ·      They are appropriate for use in the home; and

    ·      They include a durable component (a component that CMS determines can withstand repeated use and has an expected lifetime of at least three years) that is capable of displaying the trending of the continuous glucose measurements.

    “In all other cases in which a CGM does not replace a blood glucose monitor for making diabetes treatment decisions, a CGM is not considered DME,” the agency states in the ruling.

    CMS says it will pay a monthly fee schedule amount of $248.38 for CGMs in 2017, plus monthly fee schedule amounts for the replacement of the sensors, transmitters and all other accessories and supplies. It says the fee schedule amount will be increased in 2018 and subsequent years based on the covered item update factors.

    The ruling is effective Jan. 12.

    Bain Capital makes bolt-on acquisition in pediatric market

    ATLANTA – Bain Capital Private Equity plans to buy PSA Healthcare, combining it with another recent purchase, Epic Health Services.

    “The combination of these two companies promises to create a unique and highly differentiated pediatric care platform that offers the highest quality care and the best clinical outcomes for our patients,” stated Rod Windley, chairman of PSA. “Together, we have the opportunity to become the fastest growing and most efficient provider network of home care to medically fragile children in the United States.”

    Per the agreement, the current equity holders of PSA Healthcare, including its senior management team and J.H. Whitney Capital Partners, its current majority owner, have agreed to roll over their current ownership interests into the newly formed affiliate.

    The combined company will be led by Windley as executive chairman; current PSA CEO Tony Strange as CEO; and several members of Epic Health’s senior management team.

    For Dallas-based Epic Health, the deal extends its geographic reach. PSA Healthcare, based here, has more than 75 locations in 16 states, including Florida, Georgia, Pennsylvania, Colorado, Texas and Louisiana.

    Financial terms of the deal weren’t disclosed.

    Epic Health announced it would be acquired by Bain Capital in December.

    Both the PSA Healthcare and Epic Health deals are expected to close in the first quarter of this year.

    Gov’t sums up healthcare fraud and abuse control

    WASHINGTON – The Department of Health and Human Services and the Department of Justice have released their “Health Care Fraud and Abuse Control Program Annual Report for Fiscal Year 2016.”

    The DME-related items in the report include:

    ·      In March 2016, Respironics paid $34 million to resolve civil False Claims Act allegations for paying kickbacks to DME suppliers to induce those suppliers to buy the company’s masks that treat sleep apnea.

    ·      In April 2016, Hollister and Byram Healthcare Centers paid $20.8 million to resolve FCA allegations that Hollister paid unlawful kickbacks to Byram with the intent to induce Byram to conduct promotional campaigns designed to refer patients to Hollister’s products.

    The report also highlights findings by HHS and the Office of Inspector General that certain DME is available to CMS at a cost well below what is available to state Medicaid agencies. In audits of four state Medicaid agencies, they found that the state could have saved $18.1 million on the purchase of certain DME items if they obtained pricing comparable to pricing under Round 1 of Medicare’s competitive bidding program.

    Deadline to sign infusion letter looms

    WASHINGTON – The National Home Infusion Association seeks signatures for a letter that urges Congress to align the effective dates of switching to an average sales price reimbursement model for Part B infusion drugs and initiating payments for infusion services.

    In the letter, addressed to Senate Majority Leader Mitch McConnell, Senate Minority Leader Charles Schumer, House Speaker Paul Ryan and Democratic Leader Nancy Pelosi, the association requests “quick action” to ensure beneficiaries have access to services, equipment and drugs.

    “The disconnect between these two provisions in the 21st Century Cures Act creates a four-year gap that needs to be closed,” states the letter. “Due to the required shift in drug reimbursement…Medicare emergency department, hospital, and infusion costs may increase for this population of beneficiaries.”

    The ASP language was built in to the Cures Act to help “pay for” key elements of the Medicare Home Infusion Site of Care Act, which were also included in the bill.

    Deadline for signatures is Jan. 24.

    CMS details 2017 calculations for oxygen

    WASHINGTON – CMS has made available its 2017 calculations for oxygen generating portable equipment, stationary oxygen contents and portable oxygen contents. Each year, the monthly fee schedule payment amounts for stationary oxygen equipment—HCPCS codes E0424, E0439, E1390 and E1391— are adjusted to make the additional payment classes for oxygen and oxygen equipment that were added in 2007 budget neutral. Separate payment classes were added in 2007 for portable concentrators, portable oxygen transfilling systems, stationary oxygen contents and portable oxygen contents. Medicare expenditures each year may not be more or less than they would have been if these separate payment classes had not been established. Therefore, the fee schedule amounts for stationary oxygen equipment are reduced by a certain percentage each year to balance the increase in payments made for the additional separate payment classes. CMS details these calculations in a new download on its website. Industry stakeholders have argued that the calculations apply a “double dip,” using this methodology and the competitive bidding rates to artificially lower payment amounts in rural areas.

    HHS finalizes appeals rule

    WASHINGTON – The Department of Health and Human Services has published a final rule that addresses the massive appeals backlog. The proposed rule, published in July, established precedential authority to the fourth level of appeals and created attorney adjudicators at the third level of appeals. The final rule did not have major modifications. It will go into effect March 20.

    CMS issues guidance for dual-eligibles

    WASHINGTON – CMS has published guidance to help states ensure access to DMEPOS is available for dual-eligible beneficiaries. Those strategies are: recommend prior approval; ensure DME claims for dual-eligibles are assessed against Medicaid’s broader coverage criteria; and ensure Medicaid is only looking for Medicare prior authorizations on those items and in those states that Medicare requires it. The guidance also states that states should consider incorporating these requirements and strategies into contracts with Medicaid MCOs.

    New data submission period opens for Audit Key

    WASHINGTON – The HME Audit Key is now open for submitting data for the fourth quarter of 2016, according to AAHomecare. The association launched the HME Audit Key in 2014 to track audit activity and present findings to lawmakers. AAHomecare recently took steps to increase participation in the Audit Key, including partnering with Brightree to begin beta testing a report that would give providers many of the answers to the toughest questions in the survey.

    Pride Mobility hits sales milestone with retail power chairs

    EXETER, Pa. – Pride Mobility Products says its provider customers have sold more than 1,000 unites of each the Jazzy Air and Go-Chair retail power wheelchairs. “The Jazzy Air has already generated $4 million in sales and $1.6 million in provider profit in just 10 months,” stated Micah Swick, director of sales. “These checkbook-friendly products prove a huge revenue generator for providers and a testimony to the vast potential within the retail market.” Both the Jazzy Air and the Go-Chair were launched in 2016. Pride says it is supporting providers with a “big digital marketing push” for these products in 2017.

    PSP Homecare taps into IPAs

    RANCHO CUCAMONGA, Calif. – PSP Homecare has obtained contracts with two Independent Practice Associations to provide products to their insured patients. IPAs are businesses organized and owned by a network of independent physicians for the purpose of reducing overhead and pursuing business ventures such as direct healthcare services contracts with employers. IPAs range in size from small three physician networks to larger organizations with hundreds of physicians. PSP Homecare believes it will obtain more contracts with IPAs as it ramps up its marketing strategy and expands into new regions. “We are only just beginning to realize the growth potential of our unique business model,” said Michelle Rico, CEO of Proto Script Pharmaceutical, which owns PSP Homecare. “With more than 600,000 IPAs and more than 4,000 other private insurers in the United States, the opportunity to expand our business on a national scale is truly enormous.”

    Ottobock partners with TaiLor Made

    AUSTIN, Texas, and ORLANDO, Fla. – Ottobock and TaiLor Made Prosthetics have reached an agreement for Ottobock to be the exclusive distributor of the TaiLor Made prosthetic foot globally, starting in the United States. “The TaiLor Made prosthetic foot is a great complement to Ottobock’s growing portfolio of prosthetic feet,” said Brad Ruhl, president of U.S. HealthCare for Ottobock. The TaiLor Made prosthetic foot is designed with toe and heel elements that move independently along with a shock absorbing mechanical spring pack. It has a unique Control Hub that houses vertical shock springs, allowing for easy in-clinic customization and optimization, according to a press release. TaiLor Made says Ottobock, with its proven track record of introducing “superior microprocessor and endoskeleton components,” is “the perfect company” to introduce the TaiLor Made prosthetic foot to the market.

    New sleep apnea device hits U.S. market

    BRISBANE, Australia – Oventus on Jan. 16 announced the U.S. launch of O2Vent, what it calls the first and only sleep disorder device cleared by the Food and Drug Administration that provides relief for snoring and obstructive sleep apnea via a unique, separate airway that avoids multiple sites of obstruction, including the nose, soft palate and the tongue. The device, which uses 3D printing technologies and is customized for each patient from medical-grade titanium, works by stabilizing the jaw position, bringing the tongue forward to reduce airway collapse, according to a press release. Oventus is launching the device first in San Francisco, as part of the G’Day Australia events being held there on Jan. 21.


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    01/20/2017
    HME News Staff

    WASHINGTON – The Department of Health and Human Services and the Department of Justice have released their “Health Care Fraud and Abuse Control Program Annual Report for Fiscal Year 2016.”

    The DME-related items in the report include:

    • In March 2016, Respironics paid $34 million to resolve civil False Claims Act allegations for paying kickbacks to DME suppliers to induce those suppliers to buy the company’s masks that treat sleep apnea.
    • In April 2016, Hollister and Byram Healthcare Centers paid $20.8 million to resolve FCA allegations that Hollister paid unlawful kickbacks to Byram with the intent to induce Byram to conduct promotional campaigns designed to refer patients to Hollister’s products.

    The report also highlights findings by HHS and the Office of Inspector General that certain DME is available to CMS at a cost well below what is available to state Medicaid agencies. In audits of four state Medicaid agencies, they found that the state could have saved $18.1 million on the purchase of certain DME items if they obtained pricing comparable to pricing under Round 1 of Medicare’s competitive bidding program.


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  • 01/27/17--11:47: N.C., Va. groups merge
  • 01/27/2017
    Theresa Flaherty

    CARY, N.C. – The move by two state associations to form one regional association follows larger industry trends of consolidation.

    In November, the Virginia Association of Durable Medical Equipment Companies (VADMEC) and the North Carolina Association of Medical Equipment Services (NCAMES) combined to form the Atlantic Coast Medical Equipment Suppliers (ACMESA).

    “We’ve been talking about it for some time and finally pulled the trigger,” said Beth Bowen, who was the executive director of both associations and will now helm ACMESA. “It’s something we needed to do to keep everybody strong but still cater to the needs of those they serve.”

    Bowen is used to juggling multiple states. She owns an association management company, TayCar, Inc., and also leads the Florida Association of Home Care Services (FAHCS) and the Association for Tennessee Oxygen & Medical Equipment Services (ATHOMES).

    “Nothing is going to really change at the state level,” said Bowen. “We still have the Medicaid payer meetings within each state but the national issues are the same, no matter if it’s North Carolina, Virginia or California.”

    Bowen has been busy consolidating administrative synergies—a big cost savings—and analyzing the fee structures of both associations as it moves forward. As with many state associations, it’s a challenge to maintain membership, Bowen says.

    “It gets harder every year,” she said. “I have people that pay dues without being asked, and others, you have to remind them of things that have happened. But, so many companies see the strength in state associations.”

    Bowen pointed to a recent win, when Blue Cross Blue Shield of North Carolina announced that it will not update current fee schedules with the 2017 rates, a win that Bowen attributes to good relationships.

    “Those relationships have to continue,” she said. “If they go away, everybody 

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    suffers.” hme


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    01/27/2017
    Theresa Flaherty

    atlanta – When ZPIC auditors come calling, it’s important not to throw up your hands in surrender because there’s too much at stake, said healthcare attorney Ross Burris.

    “They can suspend your payments; they can revoke your status,” said Burris, a shareholder with Polsinelli. “That six-month revocation can turn into 12 months. You’ll be shocked at the aggressive nature and authority of some of these contractors.”

    ZPIC audits are typically provider specific and contractors will hit you with multiple requests for information. Under prepay review? You could find them looking at your previous payments, as well.

    “Contractors have an image in their heads and you need to change that image,” said Wayne van Halem, president of The van Halem Group. “You’re not committing fraud.”

    Contractors perform two types of audits: reactive, which are the result of allegations of fraudulent practices; and proactive, which account for 95% of claims and are based on data analysis.

    “We saw bid winners put on 100% prepay review during the first round of competitive bidding because data analysis showed a spike in billing,” said van Halem. 

    Once the ZPIC contractors decide to audit you, their first step is often to interview patients to see if they know the referring physician and whether they are using the equipment.

    “As a lawyer I find it incredible that, two years after the fact, they can (rely on beneficiaries’ memories),” said Burris. “On appeal, you might point that out to the ALJ.”

    Ultimately, the seven ZPIC zones will transition to five UPIC zones. With a potential 10-year, $2.5 billion contract at stake, expect things to heat up as contractors jockey for a piece of the audit pie, says van Halem.

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    01/27/2017
    HME News Staff

    WASHINGTON – NCART has formed a work group and developed an issue paper in response to CMS’s decision not to allow separate billing for titanium wheelchair frames and heavy duty upgrades.

    The agency argues these features are included in the initial fee schedules developed for manual wheelchairs.

    “This is the most recent example of policy changes and re-interpretations over the past few years implemented by CMS and its contractors that eliminate access,” said Don Clayback, executive director of NCART. “This policy announcement prevents Medicare beneficiaries with disabilities from obtaining complex rehab technology, even in they are willing to pay for the upgrades themselves.”

    In its issue paper, NCART argues that CMS must rescind the announcement, and issue a policy clarification stating suppliers can use K0108 to bill for titanium for wheelchairs for K0005, and can use K0108 to bill for heavy duty upgrades for K0004, K0005 and E1161 manual wheelchairs.

    NCART says it has reached out to CMS to express its concerns, and is pursuing “other channels in the congressional and advocacy arenas.”

    F&P responds to potential Trump tariff on Mexico

    WELLINGTON, New Zealand – Fisher & Paykel Healthcare will consider switching manufacturing of U.S. products from Mexico to New Zealand if President Donald Trump’s administration taxes Mexican imports, Yahoo Finance reports. “We’ve got two plants, one in New Zealand and one in Mexico,” CEO Lewis Gradon told Yahoo. “We have the capacity to supply the United States from New Zealand if that makes more economic sense.” Shifting manufacturing to New Zealand would raise production costs, Gradon said. The White House has said one of the ways it is considering paying for a wall along the border with Mexico is a new 20% tax on goods coming from the country.

    Rep. Price says audits should focus on actual fraud

    WASHINGTON – Rep. Tom Price, R-Ga., nominee for secretary of Department of Health and Human Services, told members of the Senate Finance Committee that he thinks the agency should focus audits on weeding out blatant fraud instead of verifying medical necessity. The comments came in response to a question from Sen. Orrin Hatch, R-Utah, about what HHS can do to protect Medicaid from scammers, according to an article on Law360. The Senate Finance committee will vote soon on whether to accept Price’s nomination.

    AmeriCare Medical takes its message on air

    TROY, Mich. – AmeriCare Medical, which provides medical staffing, private duty nursing, DME and specialized pharmacy services, has launched a TV show to address a variety of health-related topics specific to baby boomers. “As baby boomers continue to age, they are finding themselves in a unique situation where they are not only caretakers for their parents, but also dealing with health concerns of their own,” said Greg Jamiam, president and CEO of AmeriCare Medical. “This new show provides this generation with the answers they need to make informed decisions about their health and future.” AmeriCare Medical is presenting “Boomer Health at Home” in partnership with local health professionals and Bloomfield Community Television. Topics will include everything from financial planning to memory care to general first aid to illness prevention. “Boomer Health at Home” is available online and on local public access channels serving the Bloomfield area. New episodes air monthly.

    CMS evaluating PMD demo

    WASHINGTON – CMS has contracted with Provider Resources to conduct an evaluation of its power mobility device demonstration project. CMS has sent letters to physicians, asking them to schedule interviews with Provider Resources to share their opinions and thoughts on the process. “Your feedback could have a direct impact on how PMDs and other services or supplies could be requested and/or processed in the future,” the agency states in its letter to physicians. As part of the demo, which kicked off in 2012, providers must submit prior authorization requests for certain PMDs.

    Permobil consolidates websites

    NASHVILLE, Tenn. – Permobil has a new website that features its entire product portfolio—not only power wheelchairs, but also seating and positioning products, and manual wheelchairs—in one place. The manufacturer has beefed up its product portfolio with the acquisitions of The Roho Group in 2015 and TiLite in 2014. “We will better serve our clients by showing our full line of rehabilitation products on the new website, all in one place,” said Larry Jackson, president of Business Region Americas. The websites for Roho and TiLite will now redirect to the new Permobil website, www.permobilus.com.

    Routine OSA screenings not necessarily necessary

    YARMOUTH, Maine – There isn’t enough evidence to support routine screenings for obstructive sleep apnea says the U.S. Preventive Services Task Force. No studies have examined whether using questionnaires to screen people without symptoms led to changes in their health, according to a statement published in the Journal of the American Medical Association. Task force member Dr. Alexander Krist said, however, that the findings shouldn't stop people with symptoms from being tested.

    Moneyline: PharMerica, FOSRx make buys

    LOUISVILLE, Ky. – Amerita, the Specialty Infusion Division of PharMerica, has acquired Fairlawn, N.J.-based Nextron, a provider of certain specialty medications in the home. The move allows Amerita to further its expansion in the eastern United States.

    “This expansion is consistent with our strategy to become a national home infusion provider,” said Greg Weishar, PharMerica's CEO, in a press release.

    Paragon Ventures served as adviser to Nextron. Terms of the deal were not disclosed.

    FOSRx closes deal

    CUMBERLAND, Md. – Factor One Source Pharmacy has acquired Metairie, La.-based Fast Access Specialty Therapeutics. Together the two companies generated approximately $136 million dollars in revenue in 2016 and are projected to generate $156 million in revenue for 2017.

    Sajal Roy, CEO of FOSRx, will become CEO of the combined companies.

    FAST, which has 42 employees and annual revenue of nearly $100 million, will retain its brand but operate under the FOSRx umbrella.

    Paragon Ventures served as adviser to Nextron. Terms of the deal were not disclosed.

    Wellness bill introduced in House

    WASHINGTON – A companion bill has been introduced in the House of Representatives that seeks Medicare payment for services such as wellness screenings, immunizations and diabetes management. H.R. 592, the Pharmacy and Medically Underserved Areas Enhancement Act, was introduced by Reps. Brett Guthrie, R-Ky., G.K. Butterfield, D-N.C., Tom Reed, R-N.Y., Ron Kind, D-Wis., and 104 co-sponsors. A Senate version of the bill was introduced Jan. 12 with 27 co-sponsors. Both bills have been endorsed by the pharmacy community, including the National Community Pharmacists Association.

    MTA pushes sleep screening

    NEW YORK – The Mass Transit Authority has said it will seek to expand sleep apnea screening to Long Island Rail Road engineers and conductors; New York City Transit subway train operators, conductors and bus operators; and MTA bus operators, according to local news reports. The proposal comes in response to a 2013 Metro-North train crash that killed four people. The Federal Motor Carrier Safety Administration has long sought to implement recommendations for sleep screening, amid push back from the transportation industry. But in the wake of the Metro-North crash, as well as other recent, high-profile crashes, the tide may finally be turning, say sleep stakeholders.

    SCA grants high-flying senior wish

    PHILADELPHIA – SCA will grant another senior wish when Jim Willis, 87, embarks on a tandem hang-glide flight Jan. 26. The resident of Bradenton Brookdale Senior Living wants to show older people that “you are never too old to try something new.” SCA, a manufacturer of personal hygiene and forest products, partners with Wish of a Lifetime and Brookdale Senior Living to fulfill dreams of seniors to shift society’s perception of aging.

     


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    01/31/2017
    HME News Staff

    WASHINGTON – Democrats on the Senate Finance Committee have boycotted a vote on President Donald Trump’s nominee for secretary of the Department of Health and Human Services, Rep. Tom Price, R-Ga., according to news reports.

    The committee was scheduled to vote at 10 a.m.

    Democrats boycotted the vote due to “truly alarming news” of a Wall Street Journal report that Price received a special discounted rate for stocks of an Australian pharmaceutical company called Innate Immunotherapies, Sen. Ron Wyden, the top Democrat on the committee, told CNN.

    “This is contrary to congressional testimony he gave,” he said.

    Democrats say they will not vote to confirm Price until they can ask more questions about his background, the Associated Press reported.

    Republicans on the committee have delayed the vote indefinitely, the AP reported.

    Price, the architect of an alternative to Medicare’s competitive bidding program called the market-pricing program, is a popular choice among HME stakeholders. His long-standing desire to repeal and replace the Affordable Care Act, popular with President Donald Trump and Republicans, also resonates with stakeholders.

    Eighty-five percent of respondents to a recent HME Newspoll said having Price as secretary would be positive for the HME industry. Fifty-six percent said his first priority should be repealing the bid program and replacing it with MPP, followed closely with 28% saying it should be repealing and replacing the ACA.

    In overseeing HHS, Price would manage an annual budget of more than $1 trillion. The agency encompasses CMS, the Centers for Disease Control and Prevention, and the National Institutes of Health, the Food and Drug Administration, among others.

    Price has endured long and grueling hearings before not only the Senate Finance Committee on Jan. 24 but also the Senate Health, Education, Labor and Pensions Committee, known as HELP, on Jan. 18.


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    02/01/2017
    HME News Staff

    WASHINGTON – CMS today announced it will consolidate all rounds of the competitive bidding program into a single competition, Round 2019.

    Round 2019 will include 141 competitive bidding areas (CBAs) and have a total of 11 product categories. Contracts will be effective Jan. 1, 2019 through Dec. 31, 2021.

    The current Round 1 2017, Round 2 re-compete, and national mail-order program for diabetes end on Dec. 31, 2018.

    CMS also announced several changes to the program for Round 2019. Insulin pumps and supplies will be added as a product category. CMS is also adding 10 new CBAs to the program for the CPAP devices and related accessories product category only.  

    The other product categories are: enteral nutrients, equipment and supplies; general HME and related supplies and accessories; nebulizers, negative pressure wound therapy; respiratory equipment; standard mobility equipment and TENS devices.

    In five of these 10 new CBAs, payment for the CPAP device, related accessories, and services will be made on a bundled, non-capped monthly rental basis, while payment in the other five CBAs will be made on a capped monthly rental basis like all other existing CBAs.

    CMS is also including a lead item bidding methodology for certain items in Round 2019 in which suppliers will bid for a lead item within a grouping of similar equipment that takes into account the costs of furnishing all of the equipment in the grouping. The single payment amount for the other items within the grouping will be based on their relative differences in fees when compared to the lead item.

    In the most recent round of bidding, Round 1 2017, providers saw an overall reduction in reimbursement of 5.2% from the Round 1 re-compete. The Round 1 re-compete saw an overall reduction in reimbursement of 37%.

    In the most recent round of the national mail-order category for diabetes supplies, providers saw the reimbursement for a box of test strips decrease by about 21%—from $10.41 to $8.32—compared to the previous round.


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    02/01/2017
    HME News Staff

    WASHINGTON – The 14 Republican members of the Senate Finance Committee have voted to confirm Rep. Tom Price, R-Ga., as secretary for the Department of Health and Human Services, according to news reports.

    Price’s confirmation now goes to the Senate floor for a full vote, likely next week.

    Democrats on the committee tried to block the confirmation for a second day by boycotting the vote, but Republicans changed the rules that required Democrats to be present for a quorum, Reuters reported.

    Democrats made headlines on Jan. 31, when they boycotted the vote on Price scheduled to take place at 10 that morning, saying they wanted more time to ask questions about his background. An article in the Wall Street Journal this week reported that Price received a special discounted rate for stocks of an Australian pharmaceutical company named Innate Immunotherapies.

    Price, the architect of an alternative to Medicare’s competitive bidding program called the market-pricing program, is a popular choice among HME stakeholders. His long-standing desire to repeal and replace the Affordable Care Act, popular with President Donald Trump and Republicans, also resonates with stakeholders.

    Eighty-five percent of respondents to a recent HME Newspoll said having Price as secretary would be positive for the HME industry. Fifty-six percent said his first priority should be repealing the bid program and replacing it with MPP, followed closely with 28% saying it should be repealing and replacing the ACA.

    In overseeing HHS, Price would manage an annual budget of more than $1 trillion. The agency encompasses CMS, the Centers for Disease Control and Prevention, and the National Institutes of Health, the Food and Drug Administration, among others.

    Price has endured long and grueling hearings before not only the Senate Finance Committee on Jan. 24 but also the Senate Health, Education, Labor and Pensions Committee, known as HELP, on Jan. 18.


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    02/03/2017
    Theresa Flaherty

    WASHINGTON – After several rounds of the competitive bidding program now under its belt, CMS has implemented improvements to Round 2019 that could curb the ongoing race to the bottom, say industry stakeholders.

    The biggest improvement, say stakeholders: the bid ceiling has been moved to the 2015 fee schedule amounts. Previously, the bid ceiling had reset to each new round of bid rates.

    “Raising the bid ceiling is a huge indication that CMS thinks they’ve hit rock bottom—and gone below rock bottom,” said Cara Bachenheimer, senior vice president of government relations for Invacare. “In order to be financially sustainable, it was necessary to raise the bid ceiling.”

    CMS on Jan. 31 announced it would consolidate all rounds of the program into a single competition, with contracts effective Jan. 1, 2019, through Dec. 31, 2021.

    Another improvement: Round 2019 marks the first time bidders will be required to obtain a $50,000 surety bond for each CBA in which a bid is submitted. That increases the stakes for bidders, say stakeholders.

    “Providers will no longer have the luxury of just declining when the bid prices come out,” said Andrea Stark, a reimbursement consultant with MiraVista. “You will forfeit the bond if you said you could do it for ‘X’ and they offer you a contract for at least ‘X’ and you don’t take it.”

    CMS has also added insulin pumps and supplies as a product category in the bid program, but stakeholders question how that will work.

    “My experience has been that most pumps are supplied directly from the manufacturers,” said Kim Brummett, senior director of regulatory affairs for AAHomecare. “Will the manufacturers really bid?”

    The other product categories are: enteral nutrients, equipment and supplies; general HME and related supplies and accessories; nebulizers, negative pressure wound therapy; respiratory equipment; standard mobility equipment and TENS devices.

    Brummett says she is disappointed that oxygen and sleep are still lumped into a singular respiratory category.

    “Forcing them together denigrates the bid,” she said.

    CMS has added 10 new CBAs—in Alabama, Iowa, Michigan, California and North Carolina—for the CPAP category only. In five of those CBAs, payment for the CPAP device, related accessories, and services will be made on a bundled, non-capped monthly rental basis, while payment in the other five CBAs will be made on a capped monthly rental basis like all other existing CBAs.

    “I think CMS is going to be watching to make sure providers in those areas don’t limit the choice to certain brands or models,” says Stark.


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    ‘Why is it important and what does it prevent?’
    02/03/2017
    Liz Beaulieu

    WASHINGTON – The members of AAHomecare’s new Hi Tech Work Group will meet face-to-face at Medtrade Spring to set next steps in their goal of getting private payers to increase reimbursement for new oxygen and sleep therapy technology, or create new payment models for them.

    Leading up to the event, members of the work group were gathering information about how payments for other product categories have been reshaped. One recent example: CMS classified“therapeutic” continuous glucose monitors as DME and assigned them a one-time fee schedule amount of $236 to $277, plus bundled monthly payments for supplies.

    “It’s interesting that they recognized the therapeutic aspect of these devices,” said Maura Toole, director of field marketing for Philips Healthcare, who is leading the work group. “Being able to monitor sleep apnea and what’s going on with mask fit, AHI and periodic breathing—these are all therapeutic benefits that providers offer with new technology. We’ve all focused on utilization, and not as much about the therapeutic benefits. That’s a way to reframe the issue to payers.”

    The work group encompasses a cross-functional representation of manufacturers and providers. Helping Toole to lead the group is Laura Williard, AAHomecare’s senior director of payer relations.

    While the work group doesn’t have a road map yet to achieve their goal, their strategy is to set a precedent with one payer, then give providers tools that they can use to motivate other payers to follow suit, Toole says.

    “With private payers, there’s no cookie-cutter, turn-key solution,” she said. “So we want some kind of mechanism that providers can use to take it further.”

    Key to setting that precedent will be proving the value of new technology, Williard said.

    “Why is it important and what does it prevent?” she said. “What outcomes can we ensure to get payment?”

    Williard, whose main job responsibility at AAHomecare is to improve the HME industry’s relationships with payers, says she believes “there is an opening there.”

    “In my initial conversations with payers, there is some openness to discussing this,” she said. “But you definitely have to prove the value of it.”


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    02/03/2017
    HME News Staff

    WASHINGTON – The 14 Republican members of the Senate Finance Committee have voted to confirm Rep. Tom Price, R-Ga., as secretary for the Department of Health and Human Services, according to news reports.

    Price’s confirmation now goes to the Senate floor for a full vote.

    Democrats made headlines on Jan. 31, when they boycotted the vote on Price scheduled to take place at 10 that morning, saying they wanted more time to ask questions about his background. An article in the Wall Street Journal reported that Price received a special discounted rate for stocks of an Australian pharmaceutical company named Innate Immunotherapies.

    Price, the architect of an alternative to Medicare’s competitive bidding program called the market-pricing program, is a popular choice among HME stakeholders. His long-standing desire to repeal and replace the Affordable Care Act, popular with President Donald Trump and Republicans, also resonates with stakeholders.

    Eighty-five percent of respondents to a recent HME Newspoll said having Price as secretary would be positive for the HME industry. Fifty-six percent said his first priority should be repealing the bid program and replacing it with MPP, followed closely with 28% saying it should be repealing and replacing the ACA.

    In overseeing HHS, Price would manage an annual budget of more than $1 trillion. The agency encompasses CMS, the Centers for Disease Control and Prevention, and the National Institutes of Health, the Food and Drug Administration, among others.

    Price has endured long and grueling hearings before not only the Senate Finance Committee on Jan. 24 but also the Senate Health, Education, Labor and Pensions Committee, known as HELP, on Jan. 18.

    Reps. Crowley, Sensenbrenner introduce separate benefit bill for complex rehab

    WASHINGTON – Reps. Joe Crowley, D-N.Y., and Jim Sensenbrenner, R-Wis., have introduced a bill that would create a separate benefit for complex rehab technology. “This legislation would guarantee that patients have access to the high-quality products and services they need to lead a more independent life,” said Crowley, chairman of the Democratic Caucus. “For those with disabilities and other medical conditions, these complex rehabilitation technology products are necessities.” Currently, Medicare classifies complex rehab products like specialized power wheelchairs and adaptive seating systems as DME, limiting access and choice for users. The bill, H.R. 750, would also help prevent fraud and abuse by requiring that a licensed physical or occupational therapist evaluate any patient seeking complex rehab products through Medicare. H.R. 1516, a previous bill to create a separate benefit for complex rehab, drew support from 172 co-sponsors. A similar bill in the Senate, S. 1013, drew support from 19 co-sponsors.

    AAHomecare to Tricare: Reprocess claims

    WASHINGTON – AAHomecare is calling on the contractors administering Tricare military health plans nationwide to reprocess claims for HME for the last six months of 2016. Congress directed Medicare to do just that in a provision included in the 21st Century Cures Act passed in December. “Congress recognized the need to provide relief for home medical equipment companies operating under drastic Medicare reimbursement cuts,” said Tom Ryan, president and CEO of AAHomecare. “It’s clear from current statutes and regulations that this relief is also applicable to the Tricare program.” AAHomecare argues that since Tricare reimbursement rates are pegged to Medicare reimbursement rates by law and by current network agreements, these plans are obligated to follow suit. The association has sent a letter to the three contractors administering the Tricare plans and the Department of Defense outlining its argument.

    Ottobock draws PE interest

    DUDERSTADT, Germany – Ottobock has attracted interest from private equity firms, including KKR and CVC, according to Reuters. The firms are looking for a 20% stake in the company core business of making artificial limbs. Ottobock is also drawing interest from buyout firms BC Partners and Advent. The company is targeting PE firms, affluent families and technology funds as potential buyers in a deal it hopes to complete by the end of June, ahead of a planned initial public offering, Reuters reported. Ottobock, which is being advised by J.P. Morgan, is currently valued at $3.2 billion. It’s currently a private company owned by the founder’s grandson, Hans Georg Naeder.

    It’s official: Inspired by Drive launches

    PORT WASHINGTON, N.Y. – Drive DeVilbiss Healthcare today announced the official launch of Inspired by Drive, a company dedicated to manufacturing positioning and mobility products for the pediatric market. “Making a difference for families of children with special needs matters to us,” said Matt Lawrence, vice president and general manager of Inspired by Drive. “The grace, love and determination of special needs families gave birth to our company name and motivates the current and future vision of the Inspired by Drive Product line.” Inspired by Drive was formed when Drive combined Columbia Medical, Specialized Orthotic Services and Wenzelite Rehab.

    Safeguard Services tapped for UPIC contract

    CAMP HILL, Pa. – SafeGuard Services has been awarded the Unified Program Integrity Contractor (UPIC) for the Northeastern Jurisdiction. UPICs are new CMS contractors that will be replacing the functions of: Zone Program Integrity Contractor (ZPIC), Program Safeguard Contractor (PSC), and Medicaid Integrity Contractor (MIC). The Northeastern Jurisdiction consists of the following states: Connecticut, Delaware, Maine, Massachusetts, Maryland, New Hampshire, New Jersey, New York, Pennsylvania, Rhode Island, Vermont and Washington DC.  

    RxWiki,TeleManager Technologies form new company

    AUSTIN, Texas – RxWiki, a digital health company, has merged with TeleManager Technologies, a communication solutions company, to form Digital Pharmacist. Digital Health’s platform enables pharmacies and patients to communicate via phone, web or text to fill prescriptions, set reminder alerts, learn about their health conditions or ask the pharmacist questions. RxWiki in December signed a five-year renewal with the National Community Pharmacists Association to offer association members access to its services.

    Arch Comfort finds new home in pharmacy

    WILKES-BARRE, Pa.  – Arch Comfort, which specializes in therapeutic and corrective footwear, has moved inside Harrold’s Pharmacy, according to the local newspaper, The Times-Leader. The owners of Arch Comfort, both certified pedorthists, said the new location will give the company more visibility and allow it to accept more kids of insurances, the newspaper reported. Arch Comfort provides personalized fittings for braces and orthotics, a shoe lab for in-house modifications, a selection of name brand orthopedic footwear and other therapeutic products. Harrold’s Pharmacy encompasses a 22,000-square-foot facility, a former bakery that the company spent $3 million to $4 million renovating in 2013.

    Essential Medical Supply taps ARI for website services

    MILWAUKEE and ORLANDO, Fla. – ARI Network Services is now the preferred website provider of the more than 2,000 independent dealers of Essential Medical Supply, a manufacturer of in-home medical and health-related products. ARI will offer Essential Medical Supply dealers special package pricing and discounts on their websites. ARI’s websites give dealers easy access to Essential Medical Supply’s full library of pre-loaded product data, and industry specific functionality, including a prescription refill module and secure online bill pay. “The effects of competitive bidding have encouraged HME providers to explore new online profit centers, and this program offers providers the opportunity to optimize their online presence to ‘Sell More Stuff’ online and in-store,” said Patrick Miller, ARI’s HME business development director.

    CCS Medical’s diabetes program earns DEAP accreditation

    FARMERS BRANCH, Texas – CCS Medical’s diabetes education program CCS Connects has been named a Diabetes Education Accreditation Program by the American Association of Diabetes Educators. CCS Connects uses health risk assessments and smart devices to collect real-time data, and also uses wireless glucose technology and clinical monitoring. CDEs interact with members every three months to provide ongoing education and coaching focused on nutrition, product training, behavioral changes and goal setting. "If we can increase high-risk member awareness to their condition, diagnosis and self-management principles, we can reduce diabetes-related ER visits and hospitalizations, resulting in reduced healthcare costs," said Kristine Erdman, vice president of clinical services for CCS Medical. CCS Medical is a mail provider of diabetes supplies, insulin pumps and continuous glucose monitors, and wound care, urology, ostomy and other supplies.

    CRT conference registration opens

    ARLINGTON, Va. – Registration is now open for this year’s National CRT Leadership and Advocacy Conference, slated for April 26–27 at the Hyatt Regency Crystal City. This year’s event has been condensed into two days; the conference fee is $199. A key focus of the event is pushing legislationto permanently delay CMS’s plan to apply competitive bidding-derived pricing to accessories for manual and power wheelchairs, and to create a separate benefit for complex rehab. NCART and NRRTS expect to have bills introduced by the event. For more information or to register: www.ncart.us or www.nrrts.org.

    CFA hosts networking reception

    LAS VEGAS – Medtrade Spring attendees will have the opportunity to attend a networking reception at the Environments for Aging Expo on Feb. 28, 5-7 p.m. EFA is co-co-locating with Medtrade Spring, which takes place Feb. 27-March 1 at the Mandalay Bay Convention Center. The networking event is $25. Register here.

    People: Cure Medical taps Wells for exec position

    NEWPORT BEACH, Calif. – Lisa Wells has been named vice president of marketing at Cure Medical. Well has more than 20 years of experience in healthcare marketing, digital technology, product development and community relations, most recently as president of Get Social Consulting. She is also the founder of several social communities for wheelchair users, including Wheel:Life, which she sold to Comfort Medical in April 2016. Cure Medical is a manufacturer of intermittent catheters and closed catheter systems. It donates 10% of net profits to research.


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    02/07/2017
    HME News Staff

    WASHINGTON – CMS has decided to temporarily delay Round 2019 of competitive bidding to give the new administration the chance to review the program.

    The agency made the announcement on Feb. 7, about a week after announcing it would consolidate all rounds of competitive bidding into Round 2019.

    CMS has removed all information on Round 2019 that was released Jan. 31, including information on the agency’s website and the Competitive Bidding Implementation Contractor website.

    The agency advises providers to continue to monitor these websites—www.cms.gov and www.dmecompetitivebid.com—for updates.

    Per CMS’s initial announcement, Round 2019 will include 141 competitive bidding areas and have a total of 11 product categories. Contracts will be effective Jan. 1, 2019, through Dec. 31, 2021. The current Round 1 2017, Round 2 re-compete and national mail-order program for diabetes supplies end on Dec. 31, 2018.

    CMS announced several changes to competitive bidding as part of Round 2019, including a new product category for insulin pumps and supplies.

    The agency also announced it would add 10 new competitive bidding areas for CPAP devices only. In five of those CBAs, payment will be made on a bundled, non-capped monthly rental basis. In the other five, payment will be made on a capped monthly rental basis like all other existing CBAs.

    Additionally, CMS announced it would use a lead item bidding methodology for certain items in Round 2019.

    Stakeholders applauded a number of changes that CMS plans to make as part of 2019, including moving the bid ceiling to the 2015 fee schedule amounts, and requiring bidders to obtain a $50,000 surety bond for each CBA in which a bid is submitted.


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    02/09/2017
    HME News Staff

    WASHINGTON – Suppliers won’t need to resubmit claims to get retroactive payment adjustments mandated by the 21st Century Cures Act, according to guidance released today by CMS.

    The Cures Act, signed into law in December, rolled back cuts that went into effect in non-competitive bidding areas from June 30, 2016, to Dec. 31, 2016, allowing providers in those areas to recoup six months worth of payments.

    In guidance released to the DME MACs, CMS said it will recalculate the fee schedule to extend the 50/50 blended fee schedule in effect from Jan. 1 to June 1, 2016, timeframe to the July 1 to Dec. 31, 2016, timeframe, according to a bulletin from AAHomecare.

    The revised fee schedule will be available to the DME MACs on or after May 1, 2017. The DME MACs can start processing affected claims as soon as the revised schedule–expected to be available May 1—is loaded into their systems.

    Suppliers don’t need to submit new claims or other materials. Instead, the DME MACs will create a one-time process to validate and adjust claims, and will automatically perform a mass reprocessing of claims. Suppliers who believe that their claims weren’t reprocessed will then need to submit a request.


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    ‘Dr. Price has a strong appreciation of the role that home medical equipment providers play in allowing people to remain in their homes,’ says AAHomecare’s Ryan
    02/10/2017
    HME News Staff

    WASHINGTON – The Senate early on Friday approved the nomination of Rep. Tom Price, R-Ga., as secretary of the Department of Health and Human Services.

    The Senate voted 52 to 47 to confirm Price, a long-time champion of the HME industry.

    “Dr. Price has a strong appreciation of the role that home medical equipment providers play in allowing people to remain in their homes when recuperating from an illness or dealing with long-term health changes,” said Tom Ryan, president and CEO of AAHomecare, in a statement. “He has been a long-time advocate for legislation that would improve Medicare reimbursement practices for home medical equipment, and has led Congressional efforts to make sure that individuals who rely on home medical equipment in rural communities and other less-densely populated areas can get the products and services they need.”

    Price, the architect of an alternative to Medicare’s competitive bidding program called the market-pricing program, is a popular choice among HME stakeholders. His long-standing desire to repeal and replace the Affordable Care Act, popular with President Donald Trump and Republicans, also resonates with stakeholders.

    Price has had a bumpy road to HHS. Democrats on the Senate Finance Committee tried to block his confirmation by the committee by boycotting a vote on Jan. 31 and again on Feb. 1, but Republicans changed the rules that required Democrats to be present for a quorum. The 14 Republican members of the committee then voted to confirm him.

    In overseeing HHS, Price will manage an annual budget of more than $1 trillion. The agency encompasses CMS, the Centers for Disease Control and Prevention, and the National Institutes of Health, the Food and Drug Administration, among others.


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    The broad underlying statute governing the program gives complete discretion to the administration, they point out
    02/10/2017
    Theresa Flaherty

    WASHINGTON – CMS’s decision to temporarily delay Round 2019 of competitive bidding could mean a revamp of the program, now that Rep. Tom Price, R-Ga., is taking the helm at the Department of Health and Human Services, say industry stakeholders.

    CMS said on Feb. 7 it was delaying Round 2019 to give the new administration time to review the competitive bidding program. The announcement came one week after the agency announced it would consolidate all future rounds of competitive bidding into Round 2019.

    “Given what we know of Price and his desire to make significant changes to the bidding program, I think this could be a good thing,” said Cara Bachenheimer, senior vice president of government relations for Invacare.

    The Senate on Friday approved the nomination of Price, a long-time HME champion and the architect of an alternative to the competitive bidding program called market-pricing program.

    Industry stakeholders have hailed the nomination of Price, but they acknowledge there’s no quick fix for the competitive bidding program.

    “I think a lot of people think Price is going to come in and just do away with competitive bidding and that’s not the case,” said John Gallagher, vice president of government relations for The VGM Group. “He can’t scrap competitive bidding, but he can rewrite it to include the market-pricing program.”

    In fact, the broad underlying statute governing the competitive bidding program gives complete discretion to the administration. Details like what products to include, what areas to include, and how to set the median bid are “all up for grabs,” Bachenheimer says.

    “There could be a major revamping of the program,” she said.

    CMS itself had outlined several changes to the competitive bidding program as part of Round 2109. Many of those changes are positive, like requiring $50,000 surety bonds for each CBA in which a bid is submitted, and moving the bid ceiling to the 2015 fee schedule.

    As head of HHS, Price will have a full plate, but stakeholders say they stand ready to press him on the competitive bidding program.

    “We have been working on our opportunities with Dr. Price as secretary since the beginning of 2017 and we are working on a strategy as we speak,” said Kim Brummett, vice president of government relations for AAHomecare. “He will have his hands full with the Affordable Care Act repeal and replace, but we hope to be able to work with him to make changes to the current program.”

     


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