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    11/17/2017
    HME News Staff

    BALTIMORE – CMS did not always follow its own procedures and federal requirements for awarding competitive bidding contracts consistently, according to a new report from the Office of Inspector General.

    CMS did not follow the bid process consistently for 23 of 215 winning suppliers, the OIG found.

    Breaking it down, the agency awarded contracts to 10 suppliers that did not meet financial statement requirements and 13 suppliers that did not have the required license in at least one competition, according to the OIG.

    The inconsistencies affected 99 of the 240 sampled single payment amounts, the OIG found.

    Additionally, CMS did not monitor suppliers in accordance with established procedures and federal requirements for another 31 suppliers. These suppliers did not maintain the applicable license required by their contract for the last six months of 2013, according to the OIG.

    With these errors, CMS paid suppliers $182,000 less than they should have, or less than .03% of the $553.7 million paid under Round 2 during the last six months of 2013, the OIG estimates.

    The report recommends that CMS follow established program procedures and federal requirements consistently; ensure that suppliers have the required licensure; and monitor supplier licensure requirements by implementing a system to identify potential unlicensed suppliers.

     


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    11/21/2017
    Jeff Rowe

    ATLANTA – Many HME providers end up in front of an administrative law judge (ALJ) to contest a reimbursement denial, but too often they don’t know what they’re up against.

    At Medtrade in Atlanta, in “What Really Happens In An ALJ Hearing?” Ross Burris, an attorney with the Kansas City-based law firm Polisinelli, was part of a panel that walked attendees through how to prepare and manage an ALJ hearing.

    HME News: Why is there a need for a session like this?

    Ross Burris: A lot of providers decide to handle these hearings without counsel or consultant. It’s often a financial decision. The problem is, they don’t know how the proceedings work.

    HME: How can providers make the most of their time at these brief hearings?

    Burris: They definitely need to be prepared. They need to understand their documentation and the basis for the denial. They also need to know how they’re going to respond because these hearings happen very quickly. The judges don’t have a lot of time, so providers need to be ready to get out their important points about why the claims should be paid

    HME: What are the pitfalls of these hearings?

    Burris: People aren’t preparing at the early stages of the appeal process with a mind toward an ALJ hearing. They’ve probably handled the first couple stages on their own, so they don’t have the necessary documentation. But by the time it gets to the ALJ it’s too late. They need to think of it as an audit and get a plan early.

    HME: Aren’t providers often successful during ALJ hearings? Why?

    Burris: More than half of providers are successful, and the fact is the prepared provider is going to have a much better track record.

    HME: If attendees take away one thing from this session, what should it be?

    Burris: Because of the hearing backlog being almost two full years at the ALJ level, people are waiting a long time to get their day in court. They must be prepared to have all their documentation, and have everybody lined up if they’re going to have physicians or nurses testify. 


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    11/21/2017
    HME News Staff

    WASHINGTON – The standard monthly premium for Medicare Part B enrollees will be $134 for 2018, the same as 2017, CMS has announced.

    Some beneficiaries who were protected from Part B premium increases in prior years will have increases in 2018, but they will be offset by the increases in their Social Security benefits next year, CMS says.

    “Medicare’s top priority is to ensure that beneficiaries have choices for affordable, high-quality care that fit their needs,” said CMS Administrator Seema Verma. “Next year, no beneficiary protected by the hold-harmless provision will see a Part B premium increase that is greater than the increase in their Social Security benefits. We encourage Medicare beneficiaries to explore their options to make an informed choice between original Medicare and Medicare Advantage before Open Enrollment ends on Dec. 7.”

    The average monthly premium for Medicare Advantage enrollees will drop to about $30 in 2018, about a 6% decrease compared to 2017, CMS estimates. More than 77% of Medicare Advantage enrollees remaining on their current plans will have the same or lower premiums for 2018, the agency says.

    The annual deductible for all Medicare Part B beneficiaries will be $183 in 2018, the same as 2017.


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    11/22/2017
    HME News Staff

    WASHINGTON – The Medicare Payment Advisory Committee made payment policy recommendations for non-competitively bid DMEPOS during a meeting earlier this month, according to Epstein Becker & Green, a healthcare law firm. MedPAC plans to recommend that CMS shift more products away from the “excessive” fee schedule to bid rates. It also plans to call for “immediate reduced payment rates for certain non-CBP products while CMS works on incorporating them into the CBP,” the law firm reports in a post for The National Review. Alternatively, MedPAC plans to recommend a policy option that would have CMS consider capping balance billing at a percentage of the fee schedule rate and reduce the allowed amount by 5% for non-participating providers, the law firm reported.

    AmerisourceBergen buys H.D. Smith

    VALLEY FORGE, Pa., and SPRINGFIELD, Ill. – AmerisourceBergen will purchase H.D. Smith for $815 million in cash, the two companies have announced.

    H.D. Smith is among the largest wholesalers in the country, providing a full line of brand name, generic and specialty drugs from 10 distribution centers across the U.S.

    “The acquisition of H. D. Smith strengthens our core business and expands and enhances our strategic scale in U.S. pharmaceutical distribution,” said Steven Collis, chairman, president and CEO of AmerisourceBergen, a provider of pharmaceutical products that generates more than $150 billion in annual revenues.

    H. D. Smith subsidiaries Triplefin, a pharmaceutical brand support provider, and Arete Pharmacy Network, a pharmacy services administrative organization, are not part of the acquisition.

    AmerisourceBergen plans to fund the acquisition through the issuance of new long-term debt.

    The acquisition is expected to be slightly accretive to AmerisourceBergen’s adjusted diluted earnings per share in fiscal year 2018, and be about $0.15 accretive to adjusted EPS in fiscal year 2021.

    For fiscal year 2018, AmerisourceBergen now expects revenue growth to be in the range of 8% to 11%, adjusted operating income growth to be in the range of 4% to 7%, and operating growth income for its Pharmaceutical Distribution Services segment to be in the range of 4% to 7%.

    The acquisition is subject to regulatory review and other closing conditions, and is expected to close in early calendar 2018.

    Part B premiums, deductibles remain stable for 2018

    WASHINGTON – The standard monthly premium for Medicare Part B enrollees will be $134 for 2018, the same as 2017, CMS has announced.

    Some beneficiaries who were protected from Part B premium increases in prior years will have increases in 2018, but they will be offset by the increases in their Social Security benefits next year, CMS says.

    “Medicare’s top priority is to ensure that beneficiaries have choices for affordable, high-quality care that fit their needs,” said CMS Administrator Seema Verma. “Next year, no beneficiary protected by the hold-harmless provision will see a Part B premium increase that is greater than the increase in their Social Security benefits. We encourage Medicare beneficiaries to explore their options to make an informed choice between original Medicare and Medicare Advantage before Open Enrollment ends on Dec. 7.”

    The average monthly premium for Medicare Advantage enrollees will drop to about $30 in 2018, about a 6% decrease compared to 2017, CMS estimates. More than 77% of Medicare Advantage enrollees remaining on their current plans will have the same or lower premiums for 2018, the agency says.

    The annual deductible for all Medicare Part B beneficiaries will be $183 in 2018, the same as 2017.

    Providers meet with Verma

    MODESTO, Calif. – Representatives of Home Oxygen Company attended a Nov. 20 meeting with Rep. Jeff Dunham, R-Calif., and CMS Administrator Seema Verma to discuss the challenges of rural providers in California. “Administrator Verma was very attentive to our needs and knowledgeable of our challenges,” said Andrea Ewert, president and CEO of Home Oxygen Company. “Our representatives were able to articulate the challenges of running a business and serving Medicare beneficiaries in this financially compressed market.” Denham is a co-sponsor of H.R. 4229, which seeks to extend a retroactive delay of a second round of reimbursement cuts in non-bid areas from Jan. 1, 2017, to Jan. 1, 2019. The bill currently has 71 co-sponsors.

    Aeroflow partners with Stratice to digitize orders

    ASHEVILLE, N.C. – Aeroflow Breastpumps & Urology has partnered with Stratice Healthcare to use eOrdersPlus to digitize orders for medical equipment. eOrdersPlus, developed and operated by Stratice Healthcare, allows Aeroflow to capture documentation, physician signatures and other order-related information using a cloud-based solution. “We are always looking for additional avenues that ease the process for our partners and provide higher quality patient care," said Amanda Baethke, strategic partnerships manager at Aeroflow Healthcare. "Their system links to all the major EHR platforms in our area, and provides an easy way for physicians to prescribe to us directly.”eOrdersPlus eliminates multiple phone calls, duplicate faxes and time-consuming data entry, creating a better experience from start to finish, Aeroflow says.

    ResMed study results published in CHEST

    SAN DIEGO – Patient engagement apps significantly improve adherence to CPAP therapy, according to a ResMed study now published in CHEST. Patients whose nightly use was remotely and self-monitored via ResMed’s Airview and myAir platforms were more than 87% adherent on therapy, compared to 70% of those only remotely monitored, according to the study. “CHEST’s publication is a significant call for clinicians to recommend self-monitoring tools for PAP patients,” said Carlos Nunez, M.D., ResMed’s chief medical officer. “I also believe these tools could help patients on therapies beyond sleep as well, since half of all patients don’t take their medications as prescribed.” ResMed has billed the study, first presented at the CHEST 2016 conference in Los Angeles, as the world’s largest to look at sleep apnea and self-monitoring, with 128,000 patients participating.

    Toyota challenge to benefit people with lower-limb paralysis

    LOS ANGELES – The Toyota Mobility Foundation, in partnership with Nesta’s Challenge Prize Centre, has launched a $4 million global challenge to change the lives of people with lower-limb paralysis, culminating with the unveiling of winners in Tokyo in 2020. The challenge seeks teams around the world to create game-changing technology that will help radically improve the mobility and independence of paralyzed people. Technology could include anything from exoskeletons, to artificial intelligence and machine learning, to cloud computing. A panel of expert judges will pick five finalists who will each receive $500,000 to take their concepts from an intelligent insight to a prototype. The winner will receive $1 million to help get their product to market. Among the ambassadors supporting the challenge is Rory Cooper, director of the Human Engineering Research Laboratories at the University of Pittsburgh.

    NSM names new CIO

    NASHVILLE, Tenn. – National Seating & Mobility has named Mark Marschke its new CIO. The national complex rehab provider recruited Marschke from a unit of Warren Buffett’s Berkshire Hathaway. He will oversee NSM’s technology strategies and solutions. Most recently, Marschke was CIO of Atlanta-based Larson-Juhl, which designs and makes picture frames. During his time at Larson-Juhl, he was a member of the Berkshire-Hathaway CIO Council.

    PHM seeks to finalize restructuring

    LAFAYETTE, La. – Patient Home Monitoring on Dec. 15 will ask security holders to vote on splitting the company in two. PHM will become a DME company specializing in delivering and servicing oxygen therapy, sleep apnea treatment and mobility equipment; and Viemed will become a respiratory company specializing in non-invasive vents for patients with COPD, CHF and neuromuscular conditions. PHM announced plans to split into two different companies last year. PHM’s board of directors has unanimously approved the arrangement and recommends that security holders also vote in favor of it. Shares of PHM will continue to be listed for trading on the Toronto Stock Exchange under PHM, and shares of Viemed will be listed under VMD.

    BraunAbility names new leader

    WINAMAC, Ind. – The board of directors of BraunAbility, a manufacturer of wheelchair accessible vehicles and lifts, has selected Staci Kroon as the company’s new president and CEO effective Nov. 27. She will also serve as the board’s director. The announcement follows the retirement of Nick Gutwein, who has led BraunAbility since 2008. Kroon comes to BraunAbility from Eaton Corp., a $20 billion global technology leader in power management solutions, where she was most recently executive vice president of Eaton Business Systems. Previously, she was president of Eaton’s automotive business in North America. Gutwein, who has elected to pursue his work in the ministry full time, will remain a member of BraunAbility’s board of directors.

    RESNA updates position paper on pediatrics

    ARLINGTON, Va. – RESNA has published an updated position paper on the application of power mobility devices for pediatric users. The goal of the paper is to share typical clinical applications, as well as provide evidence from literature, supporting the application of power mobility for young children and to assist practitioners in decision-making and justification. The paper, approved by RESNA’s board of directors on Nov. 2, has now been updated with more current and additional scientific literature. The paper, which was worked on by a working group of three or more experts and underwent a 30-day public comment period, is valid for five years.


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    11/28/2017
    HME News Staff

    WASHINGTON – CMS wants state Medicaid programs to submit their DME fee schedules using a new spreadsheet to make sure they’re not paying too much for equipment, according to a notice in the Federal Register.

    CMS says the spreadsheet will help the agency comply with a provision in the 21st Century Cures Act that requires it to cap Medicaid reimbursement for DME at Medicare reimbursement starting Jan. 1, 2018.

    “We would require the minimal amount of information be collected from states to comply with this statute (at 8 hours per state per year),” the agency states in the notice. “More specifically, we would ask states to demonstrate compliance by filling in their DME fee schedules onto the new spreadsheet page with the relevant information—HCPCS code series A, K, and E only, that are relevant to this information collection of durable medical equipment.”

    CMS is accepting comments on the new program through Jan. 29, 2018.

    Industry stakeholders have been waiting for details on how CMS plans to comply with the provision in the Cures Act. The provision was included in the act as a “pay-for.”


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    11/29/2017
    HME News Staff

    FALLS CHURCH, Va. – The Office of Medicare Hearings and Appeals receives more than a year’s worth of appeals work every 24 weeks at the third level of appeals, according to a recent PDF posted to the agency’s website.

    As of the end of the fourth quarter of fiscal year 2016, the pending workload at the administrative law judge level exceeded 650,000 appeals, while annual adjudication capacity going forward was about 92,000 appeals, according to the “HHS Primer: The Medicare Appeals Process.”

    At the first and second level of appeals, CMS is currently meeting its statutory timeframes to process appeals and is not experiencing a backlog, HHS says.

    At the fourth level of appeals, the Medicare Appeals Council is currently receiving more than a year’s worth of appeals work every 10 weeks. As of the end of the fourth quarter of fiscal year 2016, the pending workload at the council exceeded 22,000 appeals, while annual adjudication capacity was about 2,600 appeals, HHS says.

    Several companies are generating a significant portion of the appeals backlog, HHS says. Four DME companies and one state Medicaid agency filed 51% of appeals at the ALJ level in the first quarter of fiscal year 2015, it says. Three DME companies filed 35% of the appeals at the second level of appeals, or the QIC level, in 2015 compared to just 12% in 2012.

    HHS says the current appeals structure encourages appellants to appeal every claim because there is no filing fee and because the minimum amount in controversy required for an ALJ hearing, $160, is substantially lower than the amount required for judicial review, $1,560.

    HHS says it has a three-pronged approach to addressing the backlog and improving the system: invest new resources at all levels of appeal to increase adjudication capacity and implement new strategies to alleviate the current backlog; take administrative actions to reduce the number of pending appeals and encourage resolution of cases earlier in the process; and propose legislative reforms that provide additional funding and new authorities to address the appeals volume.

    Without administrative action, HHS estimates the appeals backlog at OMHA will exceed 1.5 million by the end of fiscal year 2021.


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    ‘The states have to ensure access to care, so they have the right to set rates to whatever they need to’
    12/01/2017
    Liz Beaulieu

    WASHINGTON – CMS has finally started to detail how it plans to implement a provision in the 21st Century Cures Act that requires the agency to cap its contribution to Medicaid reimbursement for DME at Medicare reimbursement starting Jan. 1, 2018.

    CMS on Nov. 28 published a notice in the Federal Register outlining its plans to require state Medicaid programs to submit their fee schedules for K, E and select A codes using a new spreadsheet to make sure they’re not paying too much for DME.

    “They will have to submit annually to Medicare: codes, descriptions, modifiers, utilization, then rates,” said Laura Williard, vice president of payer relations at AAHomecare. “They have added a column based on our feedback for them to specify the allowable, rural, non-rural, etc.”

    Stakeholders have been working most of this year trying to get additional information from CMS and state Medicaid programs about how they plan to implement the provision. The Cures Act was signed into law nearly a year ago, on Dec. 13.

    While the spreadsheet gives stakeholders some new information, they’re still waiting for CMS to issue a letter to the state Medicaid programs with additional guidance, particularly on reimbursement.

    “Which Medicare rates?” asked Seth Johnson, senior vice president of government affairs for Pride Mobility Products. “They’re saying bid rates, but if you look at any number of states, there are multiple bid rates. Which ones are they going to use?”

    Williard has heard the letter might be issued before an upcoming State Operational and Technical Assistance conference call on Dec. 7, which she plans to participate in.

    “The letter has been sitting at the Office of Management and Budget for approval for about two months now,” she said.

    Stakeholders on a national and state level have been educating Medicaid programs that the provision doesn’t necessarily mean they have to set their reimbursement at Medicare reimbursement. They have succeeded in getting some programs to hold off from making any changes pending additional guidance, but things are down to the wire.

    “The states have to ensure access to care, so they have the right to set rates to whatever they need to,” Williard said. “It just impacts the overall federal match.”

    And therein lies the rub: State Medicaid programs can decide to set reimbursement at higher than the Medicare reimbursement, but they’ll have to make up for the reduced contribution from Medicare.

    “That’s why we’re concerned they’ll just go and change their rates to Medicare rates just to comply and be done with it, instead of doing their due diligence,” Williard said. “I don’t think most will do that, but it’s a concern.”

    Stakeholders believe states whose Medicaid programs are largely administrated by managed care organizations may be exempt from the provision, which would help.

    “Until that’s actually verified, though, I’m not going to breathe a sigh of relief,” said Rose Schafhauser, who leads a number of state HME associations.


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    12/01/2017
    Theresa Flaherty

    WASHINGTON – The Medicare Payment and Advisory Committee offered a mixed bag of observations about the competitive bidding program at a recent meeting, but they likely won’t lead to any significant changes, say industry stakeholders.

    MedPAC plans to recommend that CMS shift more products away from the “excessive” fee schedule to bid rates.

    “There were different opinions among the various commissioners, with some saying it was great, but all they are doing is looking at the decrease in prices,” said Cara Bachenheimer, senior vice president of government relations for Invacare. “No one was talking about access issues or anything like that.”

    The committee plans to recommend CMS expand the bid program to include other product categories, including off-the-shelf orthotics and urological supplies, says Kim Brummett, vice president of payer relations for AAHomecare, which is developing a white paper on why urology and ostomy, in particular, are not good candidates for the program.

    “When you competitively bid, you are bringing it down to the lowest common denominator and patients have such different needs,” she said.

    AAHomecare will continue to monitor MedPAC, but Brummett says she doesn’t think there is immediate cause for concern. For one thing CMS doesn’t believe it has the authority to expand the bidding program without a statute. For another, stakeholders are slowly but surely getting the word out about issues with the program.

    “I think there’s enough information going around CMS with the access to care study and some of the other stuff, that I can’t imagine CMS is actively entertaining adding more to it, at least not for 2019,” she said.

    Of greater concern among MedPAC’s recommendations: requiring suppliers to be participating suppliers, thus limiting their ability to charge the beneficiary when billing unassigned. That would be a major problem in non-bid areas, says Bachenheimer.

    “They are talking about protecting beneficiaries and limiting the amount you can charge them,” she said. “But, in the non-bid areas, that’s how a lot of people are surviving. It’s not financially feasible.”


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    ‘They assume we’re just going to be silent and take it’
    12/01/2017
    Liz Beaulieu

    SPRINGFIELD, Ill. – IlliniCare Health Plan may be only one Medicaid managed care organization with plans to drastically cut payments for DME in only one state, but when its parent company is Centene Corp., which has MCOs in 28 states, HME providers everywhere take notice.

    IlliniCare plans to cut reimbursement for DME up to 50% on Jan. 1, a move delayed from Oct. 1.

    “I would say the severity of these cuts is unprecedented in my experience,” said Kam Yuricich, who runs the Great Lakes Home Medical Services Association, which represents providers in Illinois, Indiana and Michigan, and who also runs other state HME associations.

    Provider Kevin Stewart took it even further.

    “The cuts are almost more severe than those of the Medicare competitive bidding program,” said Stewart, the executive director for DME for St. Vincent Health in neighboring Indiana and president of the association. “At least with bidding, even though the process was flawed, you had a chance to bid. This just came through—this is what you get, sign the contract or not.”

    As it stands, reimbursement for CPAP masks will be 50% of the current Medicaid fee schedule if you’re a provider caring for a recipient being managed by IlliniCare, one of six MCOs in the state. For enteral nutrition, 70%; for oxygen therapy, 60%; and it goes on.

    Stakeholders are doing everything they can to fight the planned cuts, including communicating their concerns to the Illinois Department of Healthcare and Family Services, who they have a good relationship with; raising awareness through stories in local newspapers; and supporting a recently introduced bill in the Senate that would require MCOs in the state to align their rates, at a minimum, with the Medicaid fee schedule.

    “There are also discussions for a similar bill in the House,” Yuricich said. “Our message is resonating pretty strongly. Whether or not there’s going to be energy thrown behind this, to make sure it doesn’t cause access problems, is unknown at this time, but I try to be chronically optimistic.”

    While MCOs aren’t new to Illinois, the state is now working toward a goal of getting more than 80% of the 3.14 million Medicaid recipients under managed care. So staying on traditional Medicaid will become less and less of an option for many.

    “We don’t actively encourage them to drop the MCO, but if there’s a problem related to coverage, we make sure they know about it,” said Dan Heckman, general manager of Heckman Healthcare in Decatur, Ill., and a member of the board of directors of the Great Lakes Home Medical Services Association. “But I don’t know how (staying on traditional Medicaid) is going to work this time around.”

    It’s hard for providers not to feel like they’re being unfairly targeted by a big corporation because of their small size—DME accounts for one half of 1% of the state’s total spending on Medicaid, according to estimates

    “They assume we’re going to be silent and just take it,” Stewart said. “But no, we’re talking about mothers with children on vents. That piece of equipment is a big thing in their lives—it is their lives.”

    Attempts to speak with a company official at Centene were unsuccessful.


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    12/01/2017
    HME News Staff

    FALLS CHURCH, Va. – The Office of Medicare Hearings and Appeals receives more than a year’s worth of appeals work every 24 weeks at the third level of appeals, according to a recent PDF posted to the agency’s website.

    As of the end of the fourth quarter of fiscal year 2016, the pending workload at the administrative law judge level exceeded 650,000 appeals, while annual adjudication capacity going forward was about 92,000 appeals, according to the “HHS Primer: The Medicare Appeals Process.”

    At the first and second level of appeals, CMS is currently meeting its statutory timeframes to process appeals and is not experiencing a backlog, HHS says.

    At the fourth level of appeals, the Medicare Appeals Council is currently receiving more than a year’s worth of appeals work every 10 weeks. As of the end of the fourth quarter of fiscal year 2016, the pending workload at the council exceeded 22,000 appeals, while annual adjudication capacity was about 2,600 appeals, HHS says.

    Several companies are generating a significant portion of the appeals backlog, HHS says. Four DME companies and one state Medicaid agency filed 51% of appeals at the ALJ level in the first quarter of fiscal year 2015, it says. Three DME companies filed 35% of the appeals at the second level of appeals, or the QIC level, in 2015 compared to just 12% in 2012.

    HHS says the current appeals structure encourages appellants to appeal every claim because there is no filing fee and because the minimum amount in controversy required for an ALJ hearing, $160, is substantially lower than the amount required for judicial review, $1,560.

    HHS says it has a three-pronged approach to addressing the backlog and improving the system: invest new resources at all levels of appeal to increase adjudication capacity and implement new strategies to alleviate the current backlog; take administrative actions to reduce the number of pending appeals and encourage resolution of cases earlier in the process; and propose legislative reforms that provide additional funding and new authorities to address the appeals volume.

    Without administrative action, HHS estimates the appeals backlog at OMHA will exceed 1.5 million by the end of fiscal year 2021.

    Bid relief bill adds co-sponsors

    WASHINGTON – A bill that would provide relief from the competitive bidding program now has 76 co-sponsors, AAHomecare and VGM Group report. H.R. 4229, introduced Nov. 2 by Rep. Cathy McMorris Rodgers, R-Wash., with 53 original co-sponsors, would extend a retroactive delay of a second round of reimbursement cuts in non-bid areas from Jan. 1, 2017, to Jan. 1, 2019. It would also address a “double dip” cut to oxygen therapy. The newest co-sponsors are Reps. Mark Meadows, R-N.C., Mike Coffman, R-Colo., Alexander Mooney, R-W.Va., Vicente Gonzalez, D-Texas, and Betty McCollum, D-Minn. More representatives are close to signing on to the bill, VGM says.

    Diabetes supplier dropped from lawsuit

    INDIANAPOLIS – J&B Medical Supply has been dismissed from a lawsuit alleging it had sold blood glucose test strips under the retail pharmacy benefit rather than the DME benefit.

    All charges were dismissed without prejudice and without costs, according to a court filing.

    The lawsuit, filed earlier this year by Roche Diagnostics and Roche Diabetes Care, claimed that they wrongfully paid millions of dollars in rebates in lost millions of dollars in legitimate sales to an alleged scheme by several pharmacies and medical supply companies.

    J&B Medical at the time said it stopped purchasing test strips from Roche in 2009.

    In addition to the Wixom, Mich.-based J&B Medical, the suit named several other Michigan companies: Binson’s Hospital Supplies and Northwood, both of Centerline; Olympus Global in East Lansing; and Delta Global in Flint; as well as Alpha XE in Cheyenne, Wyoming.

    AOPA says O&P must remain essential health benefit

    WASHINGTON – The American Orthotic and Prosthetic Association has submitted comments on a proposal to provide individual states with increased flexibility to define essential health benefits. In its comments on the “Patient Protection and Affordable Care Act; HHS Notice of Benefit and Payment Parameters for 2019”, AOPA reiterated its position that orthoses and prostheses must remain essential health benefits and that any action by CMS to restrict or reduce access to O&P services is not in the interest of patient care. The association believes that expanding the authority of individual states to define what counts as EHB, will likely benefit insurers who look to reduce costs by limiting coverage. 

    Blue Mint Pharmacy hunts for HME

    HOUSTON – Blue Mint Pharmacy, a four-year-old online pharmacy, has added home medical equipment to its services to grow its customer base, it announced Nov. 29. It will not carry an inventory of HME but act as a “personal bargain hunter,” taking inquiries for specific equipment and searching across the country for the lowest available price. The company already uses this strategy for pet medications. “There is a need for affordable home medical equipment,” said CEO TJ Blackwell. “We want to make sure Americans can pay for and bring home the supplies they need to recover quickly from health events and enjoy a high quality of life with chronic conditions.” Blue Mint Pharmacy is a locally owned, full-service, independent pharmacy based in Houston. It specializes in retail and customized, compounded medications, and accepts most major insurance prescription plans.

    Huggenberger, Whitfield tapped by Sommetrics

    SAN DIEGO – Sommetrics, a maker of products focused on improving sleep quality, has named Raymond Huggenberger, former Inogen CEO to its board of directors, it announced today. Huggeberger has more than 20 years of experience in the healthcare industry. Prior to joining Inogen, he held leadership roles at Sunrise Medical. Sommetrics has also named Randall Whitfield to its advisory board. Whitfield has 15 years of experience in the respiratory field, including leading various business groups at Philips Healthcare, president of the business unit at Respironics and president of Puritan Bennett. Sommetrics recently partnered with AvantSleep to distribute its aerSleep sleep apnea therapy system in Canada.

    BioScrip bolsters management team

    DENVER – BioScrip has added two new execs to its management team: Harriet Booker as senior vice president and COO, and Danny Claycomb as senior vice president of revenue cycle management. Most recently, Booker was interim senior vice president of revenue cycle management for Option Care. She has also worked at Coram/CVS Specialty Infusion Services, Coram Specialty Infusion and Apria Healthcare. Most recently, Claycomb was senior vice president of revenue cycle management at Envision Healthcare. He has also worked at Coram/CVS Specialty Infusion Services, Coram Specialty Infusion and Medtronic. “On behalf of our board and management team, I am excited to welcome Harriet and Danny to BioScrip,” said Daniel Greenleaf, president and CEO, who joined BioScrip in 2016 after helping to turn around Home Solutions and Coram. “Harriet and Danny each have extensive industry experience in both public and privately held healthcare companies, and a proven track record of driving profitable growth, achieving targeted metrics, and motivating strong team performance.”

    Vertess adds DME exec

    TUCSON, Ariz. – Vertess, a healthcare M&A advisory firm, has added DME executive Eric Hymes as managing director. Hymes’ past experience includes a stint as general manager and senior executive with medical supplies provider CCS Medical, where he had responsibility for more than $100 million in P&L. “While my career in healthcare has always been focused on the end user and their families, the apex of my experience was successfully navigating an ever-shifting landscape of healthcare insurance policy and associated reimbursement pressures,” he said. “This created an environment where the most dynamic and well managed companies were always the market leaders and market survivors.” Hymes joined the M&A market in 2013, when he built a platform company in urological DME products and services, and then left the company as a “top 10 contender” in the market. At Vertess, he will focus on the DME (diabetes, insulin pump, orology, ostomy, incontinence, advanced wound care dressings) and specialty physician practice verticals.

    Medtrade Spring 2018: Special early bird rates in effect

    LAS VEGAS – SmartSaver registration rates for Medtrade Spring 2018 are now in effect. The SmartSaver rates are $25 for the expo and $99 for the conference, a big savings over early, advance and regular rates, say conference organizers. Medtrade Spring is scheduled for March 27-20 at the Mandalay Bay Convention Center. SmartSaver rates are in effect until Dec. 10. To register: https://registration.experientevent.com/showMTH182?flow=attendee


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    12/07/2017
    HME News Staff

    WASHINGTON – National health spending increased 4.3% in 2016 compared to 5.8% in 2015, according to a new study by the Office of the Actuary at CMS.

    The health spending share of the economy was 17.9% in 2016.

    Previously, the health spending share of the economy increased 0.5 percentage point from 17.2% in 2013 to 17.7% in 2015.

    The increases in health spending share of the economy were attributed to coverage expansion for 8.7 million individuals gaining private health insurance under the Affordable Care Act and 10.2 million gaining Medicaid coverage.

    Medicare

    Medicare spending grew 3.6% to $672.1 billion in 2016, slower growth than 2015 (4.8%) and 2014 (4.9%). The slower growth in 2016 was due to slower growth in spending for both fee-for service (1.8% vs. 2.2% in 2015), and Medicare Advantage (7.4% vs. 11.1% in 2015).

    Medicaid

    Medicaid spending growth grew 3.9% to $565.5 billion in 2016. State and local Medicaid expenditures grew 3.2%, while federal Medicaid expenditures grew 4.4% in 2016. Medicaid spending grew 11.5% in 2014 and 9.5% in 2015, due in part to the ACA.

    Private health insurance

    Private health insurance spending increased 5.1% to $1.1 trillion in 2016, a decrease from the 6.9% in 2015. The deceleration was largely driven by slower enrollment growth in 2016 after two years of faster enrollment growth due to ACA coverage expansion.

     


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    12/08/2017
    Liz Beaulieu

    WASHINGTON – CMS has rolled out a new settlement option for low-volume appeals, but it’s not likely HME providers will take the agency up on its offer, stakeholders say.

    Providerswith fewer than 500 appeals pending at the Office of Medicare Hearings and Appeals and the Medicare Appeals Council combined as of Nov. 3, 2017 with a total billed amount of $9,000 or less per appeal could be eligible, if certain other conditions are met.

    The kicker: CMS will settle eligible appeals at 62% of the net allowed amount.

    “It’s a tricky situation,” said Andrea Stark, a reimbursement consultant with MiraVista in Columbia, S.C. “We need the cash now, in light of reimbursement cuts, so we might be tempted to take 62%, but if we really do expect most claims to be reversed favorably, we get 100%. That’s the give and take.”

    Ross Burris, an Atlanta-based healthcare attorney with Polsinelli, put it this way: “You have a better shot of getting everything during an ALJ hearing—if you can wait, and that wait is now almost three years.”

    The low-volume appeals settlement follows similar offers to acute care and critical care access hospitals to resolve pending appeals in exchange for timely partial payment of 68% of net payable amount.

    Another drawback of settling, says Wayne van Halem, president of Atlanta-based The van Halem Group: Claims remain denied in the system, meaning any subsequent claims for related supplies, for example, also remain denied.

    “It’s not a discussion about medical necessity—it’s just a discussion about money,” he said. “So it may behoove us to stay in the process, because then it will apply to subsequent claims.”

    But what about that wait?

    “They are using it as a bargaining chip,” van Halem said. “They’re saying, you only have 10 claims assigned to an ALJ, and 790 are sitting there and will be for a long time. That’s frustrating. The settlements that I’ve been involved in have not been great experiences.”

    Stark also feels like the settlement offers are not in good faith, particularly when CMS has said, in its litigation with the American Hospital Association, that it can’t clear the backlog at the ALJ by 2021 as ordered, because it needs to look at each claim and verify medical necessity.

    “I don’t know if it’s a really great way to avoid accountability,” she said, “and none of it fixes the underlying problem of trying to figure out how not to get claims to the ALJ in the first place.”

     


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    12/08/2017
    HME News Staff

    ELYRIA, Ohio – Invacare will reduce its workforce by about 110 employees to generate $8.5 million in pre-tax savings, the company announced Dec. 7.

    The move, which affects employees in North America, is part of a multi-year strategic plan to transforms Invacare into a more clinically focused company, says Matthew Monaghan, chairman, president and CEO.

    “This reduction in force, while difficult, is an essential part of the second phase of our transformation toward becoming a more sustainably profitable, growing business," he said. "We are realigning our North America infrastructure with our new sales levels and finding more efficient ways to do business. Through this action, we are empowering employees to drive simplification and enhance customer engagement. We expect the result to lead to improved cost-effectiveness as we pursue growth.”

    In November, Invacare reported net sales of $79.5 million for the third quarter of 2017, a 2.3% increase from the prior quarter.

    Due to the reduction, Invacare expects to incur restructuring charges of about $2.6 million on a pre-tax basis in the fourth quarter of 2017.

    This latest round of lay-offs comes less than a year after the company announced in January that it would reduce its workforce by approximately 100 employees.

    Vent bill back in play

    WASHINGTON – Three senators have introduced a bill that would, they say, establish a clear medical guideline for non-invasive ventilators, the VGM Group reports.

    S. 2175, the “Beneficiary Respiratory Equipment Access and Transparency to Home Ventilator Care” or the BREATH Act of 2017, would also pave the way for providers to receive a possible increase in reimbursement for non-invasive vents, pending any decreases in utilization.

    Sens. Bill Cassidy, R-La., Charles Grassley, R-Iowa, and Joe Manchin, D-W.Va., introduced the bill on Nov. 30.

    Cassidy and Grassley also introduced a similar bill last year, in response to sweeping changes that CMS has made to non-invasive vents, including reducing the number of codes for the product category from five to two, and reducing reimbursement by about 33%.

    A companion bill in the House of Representatives will likely be introduced soon, with Rep. Larry Bucshon, R-Ind., leading those efforts, according to VGM.

    In the past, stakeholders have also supported efforts by several pulmonary groups to get CMS to reconsider its national coverage determination for vents. In particular, the groups want the agency to clinically define respiratory failure and mechanical ventilators/ventilation; and create objective, consistent criteria for providing the products.

    Gilligan replaces Diamond as Drive CEO

    PORT WASHINGTON, N.Y. – Drive DeVilbiss Healthcare has named Bob Gilligan, former CEO of GE Industrial Solutions, as its new CEO. Gilligan replaces Harvey Diamond, who has assumed the role of vice chairman. In his new role, Diamond will serve as senior adviser to the company and as a “voice to customers, vendors and investors,” according to a press release. He will also continue to serve as a member of the company’s board of directors. Gilligan brings to Drive more than 30 years of experience in both manufacturing and services businesses in industries spanning health care, technology, and heavy industrial and electric utilities. In his latest role, Gilligan successfully led the transformation of GE Industrial Solutions into a $3.6 billion global business.

    Growth in health spending slows

    WASHINGTON – National health spending increased 4.3% in 2016 compared to 5.8% in 2015, according to a new study by the Office of the Actuary at CMS. The health spending share of the economy was 17.9% in 2016.  Previously, the health spending share of the economy increased 0.5 percentage point from 17.2% in 2013 to 17.7% in 2015. The increases in health spending share of the economy were attributed to coverage expansion for 8.7 million individuals gaining private health insurance under the Affordable Care Act and 10.2 million gaining Medicaid coverage.

    PharMerica sells to investment firm

    LOUISVILLE, Ky. – PharMerica, a specialty pharmacy services provider, has been acquired by global investment firm KKR and Walgreens Boots Alliance, it announced Dec. 7. PharMerica shareholders will receive an amount in cash equal to $29.25 per share of PharMerica common stock, without interest, and its stock will cease trading on the NYSE, according to a press release. PharMerica operates 96 institutional pharmacies, 20 specialty home infusion pharmacies and 5 specialty oncology pharmacies in 45 states. In March, PharMerica acquired New Hyde Park, N.Y.-based CareMed Specialty Pharmacy.

    Butler marks 60 years, throws party

    LEWISBERRY, Pa. – Butler Mobility Products will hold a ribbon cutting ceremony and open house to celebrate its 60th anniversary at its new corporate headquarters on Dec. 13. The daylong celebration, held at 571 Industrial Drive in Lewisberry, Pa., will feature special discounts and coupons, gift certificate giveaways and food, according to a press release. "We are excited to share our new facility, expansion of mobility equipment and special 60th year celebration with our special guests and community," said Butler Mobility President and CEO Michael Carlini.  Butler is best known for its Inclined Platform Lifts.

    ResMed named finalist

    SAN DIEGO – ResMed has been named a finalist for “Medtech Company of the Year” by MD+DI, a news resource in the medical device and diagnostic industry. Among ResMed’s accomplishments, MD+DI highlighted its milestone of capturing 1 billion nights of monitored sleep apnea therapy and a CHEST-published study showing its self-monitoring app myAir can help boost therapy adherence to 87%. “ResMed has made strides this year in encouraging patient adherence with treatment and easing their ability to track progress,” MD+DI stated in its announcement. MD+DI will announce the “Medtech Company of the Year” on Dec. 11. Other finalists include Abbott, Baxter, Bigfoot Biomedical and Pentax Medical.

    NSM lands distribution deal for Splashy

    NASHVILLE, Tenn. – National Seating & Mobility has been named the exclusive U.S. distributor of the new Splashy portable bath seat from Firefly. The seat adapts to a child’s postural support needs, with the option of a five-point harness or the three-point pelvic support. “The Splashy is a great addition to our product offerings for children with mobility needs and their families,” said Bill Mixon, CEO. The seat will be available through NSM and AccessNSM branches nationwide. U.K.-based Firefly is part of the Leckey Group, a designer and manufacturer of clinically focused pediatric postural support products.

    Provider short takes: Integrated HomeCare, VitalCare

    Rockford, Ill.-based Integrated HomeCare Services has opened a new storefront in Beloit, Wis., according to the Beloit Daily News. Integrated HomeCare has served customers in Beloit for the last 30 years, but CEO Mark Hatch told the newspaper “it was time” to open a storefront in the city to grow its presence in the Stateline Area. “We felt there was a marketplace need, so we organized all the pieces to get it going,” he said. Integrated HomeCare’s top-selling HME include sleep therapy equipment, beds, mobility products and lift chairs…Cheboygan, Mich.-based VitalCare, the home care, hospice, private duty, HME and adult day center affiliate of McLaren Northern Michigan, will take the McLaren name starting Jan. 1, according to the Cheboygan News. The HME business, specifically, will be renamed McLaren Home Medical Equipment.

    People news

    Laura Williardhas been appointed to the Board of Directors for the Home Medical Equipment & Services Association of New England. Williard is vice president for payer relations at AAHomecare…VGM & Associates has announced that Scott Owen will transition from vice president of sales to vice president of contracting. Taking Owen’s spot as vice president of sales: RJ Meyer, previously with Biotronik Cardiac Rhythm Management…Merits Health Products has named Kirk Grau as regional rehab sales manager of central U.S. and Bret Tracy as regional rehab sales manager of East Coast. Grau and Tracy will work directly with Chris Blackmore, national director of business and product development. 


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    12/14/2017
    HME News Staff

    WASHINGTON – The HME industry has at least one more detail about a competitive bidding-related interim final rule that has been under wraps and stuck at the Office of Management and Budget.

    The OMB, which included the IFR in its semi-annual Unified Agenda, says it “amends the regulation to resume the transition period for items furnished from August 1, 2017, through December 31, 2018.”

    H.R. 4229 would extend the transition period from Jan. 1, 2017, to Dec. 31, 2018.

    The transition period refers to a provision in the 21st Century Cures Act that delayed a second round of reimbursement cuts in non-bid areas from July 1, 2016, to Jan. 1, 2017.

    The Unified Agenda of Federal Regulatory and Deregulatory Actions is a compilation of information about regulations under development by federal agencies published in the spring and fall.


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    12/15/2017
    Theresa Flaherty

    WASHINGTON – New details have pushed to the forefront a competitive bidding-related interim final rule that’s been held up at the Office of Management and Budget since August.

    “We continue to ask members who have relationships with the OMB to put calls in,” said Tom Ryan, president and CEO of AAHomecare.

    The industry last week gleaned new information about the under-wraps IFR when the OMB included it in its semi-annual Unified Agenda. The OMB states: the IFR “amends the regulation to resume the transition period for items furnished from August 1, 2017, through December 31, 2018.” That’s a shorter duration than proposed in H.R. 4229, which would extend the transition period from Jan. 1, 2017, to Dec. 31, 2018.

    The OMB also included a new IFR in the Unified Agenda, this one to amend the methodology for establishing single payment amounts for items furnished under the bid program.

    In a double-pronged strategy, the industry continues to gather support for H.R. 4229, which has collected 94 co-sponsors in six weeks.

    “We continue to talk to our champions, Rep. Cathy McMorris Rodgers, and Sen. John Thune,” said Jay Witter, vice president of government relations for AAHomecare. “They are working with the committees on ways of getting this fixed. They clearly understand the timing of this issue.”

    AAHomecare also continues to release tools that stakeholders can use to gather support for bid relief, most recently a white paper, “Why Urban Areas Must Help Stop Drastic Cuts to DME Items in Rural & Non-Bid Areas.” The paper outlines several key ways in which urban areas will benefit from the bill, even though it’s focus in non-bid areas.

    “There’s been some questions about how this helps bid areas,” said Ryan. “This explains that. I keep talking about the domino effect of managed care plans using unsustainable bid rates and taking a deduction off of that for all areas.”

    Lawmakers will likely break for the holiday recess Dec. 21 or Dec. 22. While the tax plan and a continuing resolution to fund the government are the two top items on their agenda, there are a few other “must pass” items that could provide a vehicle for H.R. 4229, including funding for the Children’s Health Insurance Program.

    “We’re doing everything we can to see if there’s an opportunity to get it passed, but (if we don’t), the bill will roll right into next year,” said Ryan. “So, when they get back, we’ll be fighting as usual.”
     


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    12/15/2017
    Theresa Flaherty

    YARMOUTH, Maine – A recent report on unlicensed suppliers receiving bid contracts re-opened old wounds for providers, who say it amounts to nothing more than a slap on the wrist for CMS.

    In a November report, the Office of Inspector General found that CMS did not follow its own processes for the competitive bidding program, and, as a result, the agency awarded Round 2 contracts to 23 suppliers it shouldn’t have: 13 that did not meet licensure requirements and 10 to suppliers that did not meet financial requirements.

    “How does this slip through the cracks and, now that it did, what are the penalties?” said Raymond Arthurs, owner of First Care Medical Supplies in Englishtown, N.J. “It makes no mention of them being excluded from the program.”

    Instead, the report merely recommends that CMS follow its established procedures consistently; ensure that suppliers have the required licensure; and monitor supplier licensure requirements by implementing a system to identify potential unlicensed suppliers.

    “It’s a slap on the wrist,” said Arthurs.

    It’s especially frustrating for providers who followed all of the rules for the program—licensure, accreditation, surety bonds—as well as all of the other rules and requirements of operating as a Medicare supplier, and have found themselves not only shut out of the program, but also feeling like no one cares.

    “The bottom line is, they screwed up,” said Bob Miller, who has closed his HME business, Hackettstown, N.J.-based Bach’s Home Health Care, after more than 30 years in business. “I think it’ still going on and AAHomecare should be all over this.”

    In the past, AAHomecare has made more noise about licensure issues, but, given the size and volume of Round 2, errors are probably to be expected.

    “Were there errors? Yes,” said Kim Brummett, vice president of regulatory affairs for the association. “Is it big enough, as another example (of a problem with the bid program)? Probably not. We will keep it in our arsenal.”


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    12/15/2017
    Liz Beaulieu

    WASHINGTON – CMS is considering expanding a demonstration project to jurisdictions A and B that allows providers to speak with reconsideration professionals by phone to try and resolve their appeals at the second level, stakeholders say.

    After hearing testimony from Ronda Buhrmester at a recent Small Business Administration hearing, CMS responded in a letter, saying it “concurs with the noted initial benefits of this demonstration and is in discussions regarding possible expansions to jurisdictions A and B.”

    “I feel like, when something is this successful, using two jurisdictions as a control group and not including them is the easy way out,” said Buhrmester, a reimbursement specialist with VGM Group. “This is a way to further reduce the backlog if they want to.”

    C2C Innovative Solutions, the Qualified Independent Contractor, kicked off the five-year demo for oxygen equipment and diabetes testing supplies in jurisdictions C and D in 2016. It expanded the demo to other product categories in the two jurisdictions in February and March 2017.

    The beauty of the demo: If the QIC issues a favorable opinion on a claim—and it does about 80% of the time—it can analyze similar pending claims at the third level, the administrative law judge, and “remand them back,” says Wayne van Halem.

    “The QIC has been able to pull back 47,000 claims from the ALJ so far,” said van Halem, president of the van Halem Group. “The most recent numbers from September show a decline in the number of ALJ cases pending, and I think the QIC demo is a testament to that.”

    While the QIC struggled to get providers to participate in the demo initially, that was an education issue more than anything else, says Andrea Stark.

    “Providers needed a little hand-holding, because they weren’t familiar with the process,” said Stark, a reimbursement consultant with MiraVista. “But it didn’t take long for them to realize it’s a win-win. If the QIC can reverse it, they will; if they can’t, you don’t lose your place in line.”


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    12/15/2017
    HME News Staff

    WASHINGTON – AAHomecare is working with outside counsel on a strategy to curb illegal online sales of durable medical equipment, after learning that third-party sellers in North Dakota sold CPAP devices through Amazon without prescriptions. Such sales typically violate state and federal laws, as well as Amazon’s own rules, the association stated in its “Wednesday in Washington” weekly bulletin. AAHomecare plans to reach out directly to the sellers and to regulators to ask them to ensure HME products requiring a prescription are not available on online marketplaces.

    NSM heads north
    NASHVILLE, Tenn. – National Seating & Mobility is opening locations in Anchorage, Alaska, and Olympia, Wash., it announced Dec. 13. The Anchorage branch will be its first in Alaska. “The continued growth of the company supports our goal to reach more clients in need of mobility solutions,” said Bill Mixon, NSM CEO. “We are excited to operate our first location in Alaska and to expand our presence in the Washington area.” NSM has been expanding across the country—it’s most recent acquisition was Mobility Unlimited in Texas.

    AAHomecare shuffles leadership
    WASHINTON – Joel Mills, CEO of Advanced Home Care in Greensboro, N.C., has been appointed treasurer of AAHomecare’s Executive Committee. He replaces Jeff Hall, president and CEO of Reliable Medical Supplies in Brooklyn, Minn. Gary Sheehan, president and CEO of Cape Medical Supply in Sandwich, Mass., will fill Mills’ at-large seat on the board of directors. In other leadership changes, Missy Cross will take over as chairwoman of the HME/RT Council, and George Kucka, CEO of Fairmeadows Home Health Center in Schererville, Ind., will fill her at-large seat on the board.

    NRRTS launches Amnesty Program
    LUBBOCK, Texas – The board of directors of NRRTS has announced an Amnesty Program for awarding the CRTS designation to new or current registrants who meet certain criteria. The program will be in effect Jan. 1, 2018, to March 31, 2018. Registrants must meet the following criteria to be eligible for the program: They must have a minimum of three years of experience providing direct services to consumers; they must be an ATP in good standing for a minimum of three years at the time of their application; and they must complete the application for registry to the satisfaction of the review chair within the timeframe. Current registrants who meet the criteria will be awarded the CRTS designation on their 2018 renewal.

    CHAP names new leader
    WASHINGTON – The board of directors of Community Health Accreditation Partner has tapped Barbara McCann as president and CEO. McCann has served as interim president and CEO since July 2017. Her experience spans executive roles with national homecare providers over the last two decades. “We are excited to have Barbara assume the position of CEO and president,” said Maureen Spivack, chairwoman of the board. “Her national experience in quality management, combined with her vision and integrity, make her the perfect leader to take CHAP forward.” McCann comes to CHAP from Interim Health, where she most recently served as the company’s chief industry officer based in Washington, D.C. Interim Health is a healthcare franchise company with more than 40,000 nurses, therapists, aides and other professionals across 43 states.

    ResMed named top corporate citizen
    SAN DIEGO – ResMed has been named one of America’s top 100 corporate citizens for the second straight year by Forbes and JUST Capital, a nonprofit that analyzes and ranks companies based on how they serve the priorities of the American people. ResMed ranked No. 76 among other large publicly traded U.S. companies and No. 2 in “Health Care Equipment & Services.” Companies were compared on issues that included worker compensation and wellbeing, customer treatment, product impact, environmental impact, community support and job creation. “This honor acknowledges that, here at ResMed, we are fulfilling our commitment to best serve our patients, physicians, providers, communities and our 6,000 ResMedians serving people in 120 countries worldwide,” said Mick Farrell, CEO. “I look forward to us raising it even higher in 2018.”

    F&P files lawsuit in Australia
    AUCKLAND, New Zealand – Fisher & Paykel Healthcare filed patent infringement proceedings against ResMed in the Federal Court of Australia on Dec. 12, alleging that some of ResMed’s products, including its AirSense 10 and Lumis non-invasive ventilators, infringe on four of its patents, according to news reports. F&P seeks damages and injunctions that would prevent ResMed from manufacturing and selling these products in Australia. F&P and ResMed have patent proceedings pending in a number of countries. Most recently, the English Patents Court sided with F&P, saying a ResMed patent for masks is invalid in the U.K.

    Medline, ROi announce agreements for wound care, incontinence
    NORTHFIELD, Ill. – Medline has been awarded two new agreements with Resource Optimization & Innovation through its Pre-Commitment Program. Per the agreements, ROi members will have access to a portfolio of products related to traditional wound care and incontinence categories, including gauze, bandages, abdominal pads, underpads and briefs. “Medline is honored to have been chosen as a collaborative partner with ROi for basic wound care and incontinence items,” said Dan Johns, vice president, national accounts, Medline. “These agreements will provide the highest quality products to help improve patient care for the ROi membership. Medline’s and ROi’s aligned goals in driving clinical outcomes, coupled with Medline’s breadth of high quality products at competitive pricing, were the driving forces in the award.” ROi serves more than 250 hospitals and 2,800 non-acute care facilities across the U.S.

    Short takes: Spina Bifida Association, CompactCath
    Lisa Wells, vice president of marketing at Cure Medical, has been appointed to the board of directors of the Spina Bifida Association. “She’s a long-term supporter of our work and mission, and we know that her extensive knowledge of the issues facing the Spina Bifida community will enrich and enhance our shared goals,” said Sara Struwe, president and CEO of the association. Wells, who has more than 20 years of experience in public relations, marketing communications and web-based product management at medical device, medical supply and health technology companies, also sits on the board of the United Spinal Association…CompactCath has received CE Mark approval as a Class III Medical Device for its flagship intermittent urinary catheter. Already distributed in the U.S., the approval paves the way for the distribution of the CompactCath in 28 countries across Europe. CompactCath, designed by a team of physicians, engineers and users that met at Stanford University, is a unisex catheter available in a variety of sizes for use by both pediatrics and adults. Its coiled packaging makes the 16-inch catheter fit in the pocket or the palm of the hand.


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    Letter outlines two options to demonstrate compliance
    12/28/2017
    HME News Staff

    WASHINGTON – CMS finally sent a letter to state Medicaid directors on Dec. 27 with guidance on a DME-related provision in the 21st Century Cures Act, just three business days before implementation.

    The six-page letter provides an outline of the provision, which requires CMS to cap its contribution to Medicaid reimbursement for certain DME at Medicare reimbursement starting Jan. 1; describes the options available to states to demonstrate compliance; and offers technical information to facilitate their calculation of expenditures.

    States have two basic options to demonstrate compliance, per the letter. They can base Medicaid reimbursement on Medicare’s fee schedule or competitive bid rates, or a lesser percentage thereof. Or they can conduct a “robust comparison” using both rate and unit utilization data to calculate what would have been the aggregate reimbursement under Medicare for those same items to demonstrate that Medicaid reimbursement is less than the allowable amount described in the statute.

    CMS will also consider “alternative approaches” that will meet a state’s specific needs provided that such approaches are sufficient to ensure compliance, the letter says.

    States have little time to notify CMS on how they plan to demonstrate compliance. If they choose to base Medicaid reimbursement on Medicare’s fee schedule or competitive bid rates, or a lesser percentage thereof, they must submit a plan amendment no later than March 31, 2018, with an effective date no later than Jan. 1, 2018.

    If states choose to submit an aggregate payment comparison, or an alternative approach to compliance, they must inform CMS by Dec. 31 and calculate the limit for their state using expenditures for the period of Jan. 1, 2018, through Dec. 31, 2018.

    CMS also notes in the letter that this will likely be an ongoing process for states, as they must account for changes to Medicare reimbursement under the Part B benefit and under the competitive bidding program to continue to remain in compliance with the statute from year to year.


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    12/29/2017
    HME News Staff

    YARMOUTH, Maine – Moves by managed care organizations to send more Medicaid business to large distributors was the most read story of 2017 at HME News.

    Here’s that story, and nine other most read stories for 2017:

    #1

    States move to single-source more and more DME

    ‘They’re commoditizing this portion of health care, and it’s scary to think about how far they’ll take it’

    YARMOUTH, Maine – Distributors have been picking up Medicaid contracts for incontinence supplies in a number of states for years. Now the stakes have been raised.

    #2

    Tougher times ahead: Impact of rate cuts pile up

    YARMOUTH, Maine – A whopping 65% of respondents to a recent HME Newspoll say they can sustain their businesses for less than a year, if they don’t get reimbursement relief.

    #3

    All eyes on new bid-related rule

    ‘It sounds like a good thing, but we just don’t know what’s in it’

    WASHINGTON – The website of the Office of Information and Regulatory Affairs and the Office of Management and Budget now shows an interim final rule pending review titled “Durable Medical Equipment Fee Schedule, Adjustments to Resume the Transitional 50/50 Blended Rates to Provider Relief in Non-Competitive Bidding Areas.”

    #4

    Turmoil continues at Pacific Pulmonary

    BAKERSFIELD, Calif. – Pacific Pulmonary Services will lay off 170 employees in July, according to a local newspaper.

    #5

    HME infrastructure crumbles

    ‘I’ve been saying for a while that I think we’ve crossed the tipping point,’ says one provider

    YARMOUTH, Maine – CMS set out to reduce the number of HME providers with competitive bidding and, as recent data shows, it has done just that, say providers.

    #6

    CMS adds teeth to bid program

    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.

    #7

    LifeCare Solutions leaves California

    Bid rates are ‘unsustainable,’ says company’s CEO

    PHOENIX – LifeCare Solutions has begun transitioning patients as it prepares to exit the California market, says company exec Robert Fahlman.

    #8

    Linde-Praxair: Will merger have impact on HME?

    MUNICH and DANBURY, Conn. – Although industrial gas giant Linde continues to dip its toe in the waters of home care, its planned merger with Praxair likely won’t have a noticeable effect on the HME industry, say M&A analysts.

    #9

    Caught on tape: Criticism of bid program mixed in with criticism of Obamacare

    Also, Secretary Price finally goes on record about access issues

    WASHINGTON – When HHS Secretary Tom Price took to Twitter last week to post several videos of small business owners speaking on the negative impact of Obamacare, one in particular caught the eye of social media-savvy HME providers.

    #10

    Pacific Pulmonary settles whistleblower lawsuit

    NOVATO, Calif. – Pacific Pulmonary Services has agreed to pay $11.4 million to resolve allegations that it participated in a kickback scheme for home oxygen and sleep therapy equipment.

     


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