1. 2006 Legislative Impact on Home Care Joan Kohorst, MA, RRT Apria Healthcare AARC Home Care Section Chair

2. 2006 n Inhalation drugs n Competitive bidding n Quality standards n Mandatory accreditation n 36 month oxygen CTS n OIG Advisory Opinion # 06-20

3. Inhalation Drug Therapy Coverage n Medicare Part B Coverage Covers inhalation drugs administered via a nebulizer under the DME benefit n CMS has decreased reimbursement for inhalation drugs three times in the last two years n CMS added a dispensing fee in 2005 and decreased the dispensing fee by 50% in 2006

4. Inhalation Drug Therapy Coverage n CMS studied need for dispensing fee and found that the dispensing fee covered shipping/handling, pharmacy activities and services Patient education Compliance monitoring / refill calls Caregiver training Care coordination In home visits

5. Inhalation Drug Therapy Coverage n CMS does not believe Congress intended that Medicare pay for pharmacy care management services as part of dispensing fee n Hence the 50% decrease in dispensing fee in 2006

6. Metered Dose Inhalers n MDIs are covered under Part D n AARC strongly recommended that CMS recognize the importance of education and training in effective use of MDIs/DPIs Qualified / credentialed health professionals Separate payment to physicians

7. Metered Dose Inhalers n CMS already provides payment for beneficiary training by a physician or physician’s staff n DME fee includes, in part, amounts for training beneficiaries on use of nebulizer equipment

8. Local Coverage Determination for Nebulizers n Levalbuterol n DuoNeb n Amikacin, atropine, beclomethasone, betamethasone, bitolerol, dexamethasone, flunisolide, formoterol, gentamicin, glycopyrrolate, terbutaline & triamcinalone

9. Competitive Bidding n MMA requires Medicare to replace the current DME payment method with competitive bidding process Durable Medical Equipment Enteral Nutrition Orthotics and Prosthetics

10. Objectives of Competitive Bidding n Reduce Medicare expenditures n Determine appropriate prices for categories of DME n Protect beneficiary access n Reduce beneficiaries’ out of pocket n Reduce proliferation of certain DME items

11. Phased-In Implementation n 10 of largest MSAs in 2007 (probably October) n 80 of the largest MSAs in 2009 n Additional areas after that n May be phased in first among highest cost and highest volume items and services

12. Status on Competitive Bidding n Final rules for accreditation of DME providers for competitive bidding program were released by CMS on August 1, 2006 www.cms.hhs.gov/competitiveacqforDMEPOS

13. Quality Standards for DME Providers n MMA requires DME providers to comply with standards n Final version of the Quality Standards were released August 2006 www.cms.hhs.gov/CompetitiveAcqforDMEPOS/04 _New_Quality_Standards

14. Quality Standards for DME Providers n Appendix A: Respiratory Equipment, Supplies and Services defines respiratory services as encompassing the provision of home medical equipment and supplies that require technical and professional services

15. Quality Standards for DME Providers n Appendix A goes on to require that “the supplier shall comply with the current American Association for Respiratory Care Practice Guidelines” on oxygen therapy in the home, long term invasive mechanical ventilation in the home, and intermittent positive pressure breathing

16. Quality Standards for DME Providers n Appendix A further requires that “suppliers shall provide training to beneficiaries consistent with the current AARC CPGs” on long term invasive mechanical ventilation in the home, O2 therapy in the home, IPPB, suctioning of the pt in the home and and providing patient and caregiver training

17. Quality Standards for DME Providers n The AARC asked volunteers from the Home Care Section to take on the task of revising these five CPGs n We made our recommendations consistent with best practices and standards of care

18. Quality Standards for DME Providers n Our revisions were submitted to the AARC for approval on 09/29/06 n Draft guidelines are making their way through the CPG Committee’s final review process now

19. DME Accreditors n All DME providers who plan to participate in the competitive bidding process must be accredited by an independent accrediting entity n CMS recommends obtaining accreditation by early 2007 accrediting providers in MSA areas first

20. Deemed Accreditors n JCAHO n CHAP n HQAA n NBAOS n BCP www.cms.hhs.gov/competitiveacqforDMEPOS n ACHC n BO/PC n NABoP n CARF n ABCOP n The Compliance Team

21. Legislative Changes / Oxygen n The Deficit Reduction Act (DRA), section 5101 requires providers to transfer title of oxygen equipment to beneficiary after 36 continuous months n 36 month rental period began on January 1, 2006 www.cms.hhs.gov/HomeHealthPPS/downloads/CMS1304F

22. Legislative Changes / Oxygen n BBA requires budget neutrality n Proposed monthly oxygen payments: 2007- 2008 = $198.40 /mo 2009 = $193.21 /mo 2010 = $189.39 /mo 2007 oxygen content will increase = $77.45 /mo 2007 add-on for transfilling equipment and portable oxygen concentrators = $51.63

23. Legislative Changes / Oxygen n Maintenance/service will be paid if reasonable and necessary and based on criteria determined by the Secretary CMS will pay for M&S visits Q 6 months for pt owned equipment CMS will pay for “loaner” while pt owned equipment is repaired CMS will pay for supplies (NC, tubing, etc)

24. Legislative Changes / Oxygen n Impact on beneficiaries Saves Medicare money Should not increase beneficiary out of pocket expenses

25. Legislative Changes / Oxygen n Supplier requirements Furnish the item throughout the entire rental period If switch-out required, replace with equipment of equal or greater value Replace equipment that doesn’t last for reasonable ‘lifetime’ Disclosure of intentions re: accepting assignment

26. OIG Advisory Opinion # 06-20 (posted 11/08/06) n It is a violation of the Civil Monetary Penalties Act (CMP) and a violation of the Anti-kickback Statute to: Provide Medicare patients with free home oxygen until the patient qualifies for coverage Provide Medicare patients with free overnight oximetry testing

27. What We Can Do n The AARC will continue to advocate on behalf of our patients thru the efforts of our Government Affairs and PACT committees n Our efforts can make more of an impact with your participation

28. 435 Activation n December 2005: AARC asked the PACT chairs to activate the 435 committee in each state n Committee members were asked to contact Congressmen to urge members of Congress to vote “NO” on S1932

29. The Response… n In the first two days there were over 1000 messages sent to Congress thru Capitol Connection, 6000+ messages in five weeks n 75% of the States responded that they activated their plan during the holiday week

30. S 1932 n Not on the winning side of the vote Washington did hear us loud and clear Nine (9) Republicans voted against S.1932 the first time around….Thirteen (13) voted against it on 2/1/06 n AARC will continue to monitor the creation of the rules and regulations regarding the DME issue Our goal is to make sure we have input on behalf of our patients

31. Please Join the Effort! n Political Become informed about issues that affect access to care n Advocacy Speak out on behalf of our patients n Contact Phone, write, e-mail, visit our legislators n Team Participate!

32. How to Use Capitol Connection n Go to www.aarc.org n Click on Advocacy n Enter your zip code to find your legislators n Choose your topic and use the talking points to write your message in the text box n Make sure to include your name, voting address, phone number and e-mail n Hit send

33. Questions? Joan_Kohorst@Apria.com home-care@aarc.org