Home Health & Hospice Week

A project that gives Medicare beneficiaries control over how Medicare spends their allotted money has stumbled in its opening months. Many providers and beneficiary advocates cheered for the consumer-directed durable medical equipment demonstration when it was announced a few years ago. It would give beneficiaries the ability to comparison shop with DME suppliers and obtain the best price for a wheelchair. Then, if the supplier's price was less than the Medicare allowable, the difference would go into an account for the beneficiary to use to pay for something that Medicare normally wouldn't cover. The DME regional carrier overseeing the project, Cigna Healthcare, provides prior authorization for the wheelchairs and also allows beneficiaries to buy items, such as a K0001 wheelchair, that they normally would have to rent. All claims must go to Cigna instead of the supplier's usual DMERC, and the beneficiary will show up with a certificate of medical necessity with sections B and D already filled out. Suppliers have hoped the project would provide an alternative to competitive bidding, allowing them to compete on price without a huge overarching government-sponsored bidding system forcing them to submit all-inclusive bids for product categories. The CD-DME system would allow beneficiaries to become more like consumers, and enable suppliers to bid for each beneficiary's individual needs. After years of planning, the project finally got off the ground in January with four Centers for Independent Living working on it. The project will run until the end of 2005, according to Cigna's Medical Director, Robert Hoover. The four CILs have been marketing the program to their clients and Cigna has started to see some claims, but so far "it hasn't been a high volume," notes Hoover. Two CILs tell Eli they haven't yet been able to sign up a single client for the CD-DME project. "Things are very slow for us right now in that particular endeavor," says Terri Adams with TRCIL Services in Pittsburgh. Out of three candidates so far, none has turned out to be qualified. One big problem: TRCIL is seeking only beneficiaries with Part B coverage and no other insurance besides Medicare. "In Pittsburgh, Medicare HMOs are big," Adams laments. TRCIL has marketed the program to professionals such as clinical staff members at rehab facilities and social service organizations. TRCIL recently won a contract with the state to become a community resource center covering the western part of Pennsylvania. "We're hoping that once we get consumers in the door for that reason, we can possibly refer them to the DME program," says Adams. Similar issues have dogged South Portland, ME-based Alpha One CIL's efforts to generate interest in the demo. Alpha One publicized the project to beneficiaries and visitors to [...]