Home Health & Hospice Week

The agency's suggested deadline takes suppliers by surprise.

There's no time to waste if you plan to meet Medicare's new accreditation requirement for durable medical equipment suppliers by its Sept. 30 deadline.

"In order to meet this deadline, CMS is encouraging all enrolled DMEPOS suppliers, except those eligible professionals and other persons exempted by law, to submit a complete accreditation application to an accreditation organization by January 31, 2009," the Centers for Medicare & Medicaid Services says in a message to providers.

CMS unveiled the suggested deadline as part of its Jan. 8 special Open Door Forum on DME accreditation.

We mean you: "Pharmacies, pedorthists, mastectomy fitters, orthopedic fitters/technicians, or athletic trainers applying for Medicare enrollment in order to bill for Medicare Part B services are not exempt from meeting the September 30, 2009 deadline for DMEPOS accreditation," CMS stresses in materials for the forum.

CMS will post an audio recording of the forum on the Special Open Door Forum Web site at www.cms.hhs.gov/OpenDoorForums/05_ODF_SpecialODF.asp by Jan. 16, CMS says.

• The Obama administration is making pro-home care remarks, but don't get too comfortable yet. In one of his Senate confirmation hearings, the nominee for Department of Health and Hu-man Services secretary, former Sen. Tom Daschle, indicated his support for home care, reports the National Association for Home Care & Hospice.

Additionally, Daschle has a history of supporting care in the home and rebalancing Medicaid spending away from institutional care. Daschle made a home care visit in 2002 and expressed his support for HHA payment adequacy, NAHC notes.

But tough budget times lie ahead, and the administration may still look to home care to fund Medicare changes.

In a Jan. 7 speech, Obama said he plans to reform entitlement programs including Medicare as part of his plan to curb federal spending, according to the New York Times. Home care with its profit margins, Medicare Payment Advisory Commis-sion recommendations, fraud and abuse problems, significant growth, and more may attract attention as a target for cuts.

Obama will release a budget plan next month with more details, he said.

• Stamped physician signatures won't work on durable medical equipment forms either.

In 2007 CMS announced a ban on stamped physician signatures for hospice forms, then last year said stamped signatures were out for HHA forms too. Now it's clarifying that stamped signatures and stamped dates won't work for DME forms, according to Dec. 31, 2007 CR 6261 (Transmittal No. 281).

"Signature and date stamps are not acceptable for use on CMNs (certificates of medical necessity) and DIFs (DME MAC information forms)," CMS says in the transmittal.

"Your Medicare contractors will accept only hand written, facsimiles of original written and electronic signatures and dates on medical record documentation for medical review purposes on CMNs and DIFs," CMS adds in a MLN Matters article on the subject.

The transmittal is at www.cms.hhs.govtransmittals/downloads/R281PI.pdf. The MLN Mat-ters article is at www.cms.hhs.gov/MLNMattersArticles/downloads/MM6261.pdf.

• Home health PPS rates for 2009 are officially on the books. CMS issued the transmittal with the new rates on Jan. 7, although the rates actually were implemented Jan. 5. CMS first published the rates in the Nov. 3, 2008 Federal Register.

Transmittal No. 1662 (CR 6341) shows the marginal 0.15 percent increase which took effect Jan. 1, thanks to a lower-than-expected inflation update and the case mix creep adjustment, which was a 2.75 percent cut (see Eli's HCW, Vol. XVII, No. 39, p. 306).

• Watch for CMS's new competitive bidding rule to come out any day now, the American Association for Homecare says. The U.S. Office of Management and Budget (OMB) has cleared an interim final rule for the Medicare DMEPOS competitive bidding program, AAHomecare reports. That means you'll likely see the rule in the Federal Register very soon.

"Because it is an 'interim final rule,' upon publication ... CMS will have the authority to re-launch the bidding program quickly, without a meaningful opportunity for public comment or input," the trade group warns.

"A proposed rule rather than an interim final rule would have allowed for greater public discussion that is sorely needed on a program of this magnitude," AAHomecare's Tyler Wilson chides. "Since the bidding program was delayed last summer ... there has been no public dialogue with CMS about the problems that led to the delay."

• Even more diagnosis codes now qualify a patient for Medicare coverage of Prothrombin time (PT/INR) monitoring for home anticoagulation management. CMS has added more ICD-9 codes for phlebitis and thrombophlebitis and venous embo-lism and thrombosis to the coverage criteria, according to Jan. 8 CR 6313 (Transmittal No. 1663).

CMS issued its original transmittal about coverage criteria in July 2008 following a National Coverage Decision, the agency notes (see Eli's HCW, Vol. XVII, No. 27, p. 214). But it inadvertently omitted 15 ICD-9 codes from the coverage list.

• Smart state lawmakers will expand their home care offerings for Medicaid. That's because "an analysis of state spending data from 1995 to 2005 shows that ... spending growth was greater for states offering limited noninstitutional services than for states with large, well-established noninstitutional programs," according to a new study published in health policy journal Health Affairs.

But states may find it difficult to commit to offering more home and community-based services in the short run. "Expansion of HCBS appears to entail a short-term increase in spending, followed by a reduction in institutional spending and long-term cost savings," says the study, "Do Noninstitutional Long-Term Care Services Reduce Medicaid Spending?"

• The new oxygen payment methodology is already taking its toll on suppliers and their employees. National chain Apria Healthcare Group Inc. is closing three billing centers in Pennsyl-vania, Seattle, Wash. and Houston. It will consolidate operations at the company's Jackson, Tenn., Phoenix and Kansas City billing locations, reports the Wilkes-Barre Times Leader. The closure will affect 55 employees in Hanover, Pa.

The Lake Forest, Calif.-based chain expects to receive 27 percent less from Medicare for oxygen, the newspaper says.

• Lafayette, La.-based chain LHC Group Inc. and New Orleans-based Ochsner Health System are partnering for a joint venture in the state. LHC will purchase 75 percent of two Ochsner home health agencies in Kenner and Raceland, and Ochsner will purchase 25 percent of LHC agencies in Houma, Lutcher, and Hammond, the company says in a release.

More than 100 Ochsner employees will become LHC employees Feb. 1, LHC adds.

• Nursing home operator National Health-Care Corp. has purchased five hospice locations in South Carolina from Advantage Hos-pice and Home Care based in Lumberton, N.C., reports the Nashville Business Journal. The locations are in Columbia, Sumter, Aiken, Myrtle Beach, and Charleston.

Murfreesboro, Tenn.-based NHC already operates a hospice in Greenville and plans to open a new location in Anderson, the newspaper adds. The new locations will go by the name NHC Hospice, reports the Charleston, S.C. Post and Courier.