INDUSTRY NOTES:
CMS Head Steps Down
Published on Wed Sep 06, 2006
Plus: Stakeholders call for revisions to new price list.
Say goodbye to Mark McClellan as administrator of the Centers for Medicare & Medicaid Services (CMS). McClellan, a physician, lasted just two years in the job but oversaw the introduction of the Part D drug benefit and other sweeping changes in Medicare, the Boston Globe notes. Mark McClellan announced his resignation as CMS administrator on Sept. 5, saying he will likely step down by early October.
A replacement for McClellan has not been named, but potential nominees include CMS Deputy Administrator Leslie Norwalk and Herb Kuhn, director of CMS' Center for Medicare Management. McClellan's successor could face tough confirmation hearings if the Democrats gain control over one or both houses of Congress, the Globe predicts. Democrats will have searching questions about the dizzying complexity of the Part D program and other recent changes, experts predict. New Price List Problematic, Suppliers Say The feds' effort to "ensure accurate Medicare reimbursement" for power mobility devices (PMDs) is off to a misguided start, says industry representatives.
In June, CMS released long awaited new Healthcare Common Procedural Coding System HCPCS) codes for PMDs. Aiming for an Oct. 1 implementation of the new codes, CMS then released draft information regarding pricing for the various new codes on Aug. 10. The agency's brief comment period ended Aug. 25.
CMS has proposed supplementing manufacturer-suggested retail prices with the retail prices culled randomly from the Internet.
"The use of Internet merchants' pricing data in developing fee schedules for the new codes will result in inaccurate Medicare payment for these products and create what may be insurmountable barriers to access for beneficiaries," charges the American Association for Homecare in an Aug. 25 letter to CMS.
Medicare-enrolled suppliers can't afford to compete with the discounted prices of Internet retailers, charges Eric Sokol of the Power Mobility Coalition in Washington, DC, citing fundamentally incompatible business models. That equals potential problems in access for beneficiaries, he warns.
PMD manufacturers and their representatives also report that a list released by the Statistical Analysis Durable Medical Equipment Regional Carrier just prior to CMS' pricing guidance misclassifies many or even most of their products. Manufacturers including Invacare of Elyria, OH, and Exeter, PA-based Pride Mobility Products have called CMS' attention to the pricing discrepancies.
Fee schedules for the new HCPCS codes are expected to be published as part of the October durable medical equipment, prosthetics, orthotics and supplies update. After the publication of the fee schedule, the DME Program Safeguard Contractors will develop an article that will provide additional information on this subject, reports Palmetto GBA. Part D Benes Have Better Access To Cancer Drugs Researchers discovered that nearly all the 3,000 Medicare Part D plans they studied covered most cancer drugs, including brand-name [...]
