Pharmacists Eye Counseling Pay To Keep Diabetic Test Strip On Shelves

From: Inside Health Policy

As retail pharmacists brace for significant Medicare pay cuts for diabetic testing supplies, some in industry are looking to getting reimbursed for counseling diabetics as a way to keep test strips and other diabetic supplies on their shelves. Retail pharmacists say they will stop selling the supplies if CMS cuts payment anywhere close to the competitive bid price for mail-order supplies, but if Medicare were to pay pharmacists for counseling diabetics, that would both save Medicare money and provide pharmacists a way to continue selling supplies, industry sources say.

CMS stands ground on Round 1 re-compete

From: HME News

by: Theresa Flaherty

BALTIMORE – With CMS’s announcement last week of the timeline for the Round 1 re-compete, it’s likely that recent unpopular changes to the program are here to stay.

Of particular concern: The re-compete, first announced in April, features about 100 new product codes and nine product categories, including an HME category comprising everything from urinals to patient lifts.

“It’s unfortunate that they lumped it into such large categories, but it doesn’t seem like CMS is going to budge,” said Cara Bachenheimer, senior vice president of government relations for Invacare. “Once they start announcing detailed timelines, they really don’t have an opportunity to make changes.”

“Although an industry which provides life-sustaining equipment and services to Medicare beneficiaries cannot be considered as akin to a mutinous legion, CMS’ punishment of them is far harsher…”

Editor’s Note:  The Center for Regulatory Effectiveness’ comments to the White House Office of Management and Budget on CMS’ Information Collection Request for the home medical equipment bidding program is attached here. 

CRE’s comments document that the initial round of their program has “reduced the small business share of the Medicare home medical equipment market by almost half from CMS projections for 2012 and radically reduces the number of Medicare supplies by 85-95%.”

Moreover, “the overwhelming consensus by academic and federal experts” is that CMS program faces the “high probability of failure in the near future” and a “near certainty of failure sometime down the road.”

Bidding Timeline for the Round 1 Recompete

From: CMS

8/16/2012 The Centers for Medicare & Medicaid Services (CMS) announces bidding timeline, begins bidder education program

8/20/2012* Registration for user IDs and passwords begins

9/7/2012* Authorized Officials are strongly encouraged to register no later than this date

9/28/2012* Backup Authorized Officials are strongly encouraged to register no later than this date

10/15/2012* CMS opens 60-day bid window for Round 1 Recompete

10/19/2012* Registration closes

11/14/2012* Covered document review date for bidders to submit financial documents

12/14/2012* 60-day bid window closes

Spring 2013* CMS announces single payment amounts, begins contracting process

Study: CMS doesn’t answer the phone

From: VGM

WATERLOO, Iowa – A study released Monday reveals that calling the Centers for Medicare & Medicaid Services results in at least a five-minute wait before a human voice is heard.

An independent accounting firm, Hogan-Hansen PC of Waterloo, Iowa, conducted the study for Last Chance for Patient Choice, a non-profit organization dedicated to ending competitive bidding for home medical equipment, and the American Association for Homecare.

Lack of clarity pervades re-supply rule, according to NewsPoll

From: HME News

by: Elizabeth Deprey

YARMOUTH, Maine – Most providers say CMS’s new re-supply rule is “about as clear as mud.”

Sixty-three percent of the respondents to the latest HME NewsPoll say they don’t have a good understanding of the rule, which requires providers to prove that re-supply items like CPAP masks are non-functioning before they replace them. The biggest unknown: a clear definition of non-functioning.

“Although I hope we do have a good understanding, it is not completely clear what CMS wants us to document,” said Sally Johnson, manager at Cuyahoga Falls, Ohio-based Klein’s Orthopedic & Medical Equipment.

CMS Seeks Comments: Attending Physician’s Certification of Medical Necessity for Home Oxygen (Reinstatement of a previously approved ICR)

Tomorrow’s Federal Register will contain a notice from CMS attached here on reinstatement of a previously approved Information Collection Request (ICR).  Under the Paperwork Reduction Act, CMS is not allowed to collect information from ten or more people/organizations without OMB’s approval.

The text of the CMS notice — which includes contact information at CMS for more information — is reprinted below:

Type of Information Collection Request: Reinstatement of a previously approved collection;

Title: Attending Physician’s Certification of Medical Necessity for Home Oxygen Therapy and Supporting Documentation Requirements;

Report casts doubt on CMS competitive bidding program

Editor’s Note:  The reference in the sub-headline of the article below to the program’s “supporters” refers only to CMS, not to independent experts who have analyzed the program.

From: Healthcare Finance News

But supporters decry the research results

Critics of a pilot program designed to lower the cost of medical equipment purchased by the Centers for Medicare & Medicaid Services (CMS) recently received support for their concerns in a new report released by the California Institute of Technology (Caltech). But while the models used by researchers confirmed earlier outside assessments of the program, the director of the program says the researchers got it wrong.

Stakeholders: Press the flesh on MPP

From: HME News

by: Theresa Flaherty

WASHINGTON – With Congress on break for five weeks and elections looming in November, it’s the perfect time to reach out to lawmakers about the market-pricing program (MPP), industry stakeholders say.

“They are more willing to listen, because they want votes and money,” said Wayne Stanfield, president and CEO of NAIMES. “Whether they will do anything or not, (who knows).”

Right now, MPP, the industry’s alternative to competitive bidding is held up in the Congressional Budget Office (CBO), where it’s awaiting a score.

CMS Releases Transcript and Audio Recording of “Inherent Reasonableness” Meeting

CMS has released a transcript and audio recording from their July 23rd Public Meeting discussing applying their “inherent reasonableness” authority to use the inherently unreasonable results from the Round 1 Rebid for Diabetic Supplies as a basis for setting prices for diabetic supplies from retail pharmacies.

The Transcript is attached here.

The audio recording (43 MB MP3 file) is attached here.

CMS’ Federal Register notice announcing the meeting is attached here.