Home Health & Hospice Week

Grandfathering period limited, CMS says.

Deciding to furnish oxygen as a non-contract supplier under competitive bidding may seem like less of a good idea when you learn the facts about grandfathering.

Durable medical equipment suppliers who didn't win bidding contracts need to make their decisions soon on whether they will furnish bid items to existing clients, noted the Centers for Medicare & Medicaid Services in its May 13 Open Door Forum for home care providers.

"Suppliers need to make these grandfathering decisions in the very near future and inform beneficiaries," CMS' Joel Kaiser stressed in the forum. CMS has issued specific requirements for the notification letters which all suppliers in bid areas must send to their patients (see Eli's HCW, Vol. XVII, No. 19).

But suppliers may not realize what grandfathering allows--and doesn't allow. Suppliers can furnish the bid item and any accessories and supplies necessary for the item, Kaiser said in response to a caller's question.

Limited time: But that lasts only through the end of the item's rental period if it's a capped rental item. So, if you furnish oxygen equipment, you'll only be able to furnish the oxygen contents while the beneficiary is renting the equipment.

Once the bene takes ownership of the item--the 37th month for oxygen patients--you no longer are allowed to furnish the oxygen itself under bidding. If the patient owns the equipment and just needs replacement contents, those aren't subject to grandfathering, Kaiser explained.

The same goes for items such as continuous positive airway pressure (CPAP) devices in the 13th month, CMS told the caller.

Not good enough: The notification letter examples CMS has given suppliers don't do a good job of explaining the limited time period for grandfathering, the caller protested.

Suppliers also should understand that they can't choose to grandfather some patients and not others for the same item. They can pick and choose which items to continue furnishing under grandfathering, but not which patients will receive those item(s), Kaiser instructed.

Don't Pick Up Equipment Too Early

If you decide not to grandfather equipment under bidding, there are stringent rules for when you may pick up your equipment from the beneficiary, Kaiser emphasized in the forum that drew more than 600 attendees.

You can't pick up your equipment before bidding starts on July 1, Kaiser instructed. And "you can't pick it up before the end of that last rental month," he added.

Example: If your patient's rental period starts June 30, you can't pick it up until the last week of the rental month--the last week of July--even though bidding starts July 1.

CMS has announced some exceptions in the bidding program. For example, even though oxygen is now a 36-month capped rental item, suppliers who take on new oxygen patients are eligible to receive another 10 months of payments if the patient is in her 25th to 35th month of rental with her previous supplier.

That's an exception to the 36-month rental limit, CMS acknowledges in May 16 Transmittal No. 340 (CR 6055).

And if suppliers start furnishing services related to providing certain complex rehab power mobility devices before the July 1 bidding start date, but don't actually deliver the device until after the start date, they can still get paid under pre-bidding rates, contractor Cahaba GBA confirms in a message to providers.

The transition policy applies to codes K0856 thru K0864 and "related accessories," the contractor says.

Date switch: Usually, the date on a DME claim must be the date of delivery. But in this exception, suppliers can use the date of the physician order for the device, Cahaba notes. Suppliers should put the accessories on the claim, too.

"Suppliers should report the date the PMD and related accessories were delivered for use in the beneficiary's home in the narrative section of the claim," Cahaba adds.The Fight Against Bidding Wages On

Meanwhile, suppliers aren't giving up the fight against bidding yet. A May 21 hearing on bidding by the House Committee on Small Business' Subcommittee on Urban & Rural Entrepreneurship took aim at bidding's problems.

"By pushing to expand this project without addressing the harm it is likely to cause entrepreneurs, CMS is undermining their ability to serve patients and their key role in strengthening the economic base of local communities," says subcommittee chair Heath Shuler (D-NC) in a release about the hearing.

Shuler listed a number of problems with the bidding program including contracts awarded to bidders with no local presence or no experience with the bid items.

"Clarity and fairness are essential to the integrity of a program like this, but the bidding process CMS has put in place lacks both," Shuler says. "Now they want to expand it without first examining the process and results? It's incredible."