Home Health & Hospice Week

Implementation on codes, LCD delayed until Nov. 15.

Medicare will still pay for a Group 2 power mobility device (PMD) when appropriate, say the feds in a recent "clarification" from the Centers for Medicare & Medicaid Services.

A Fact Sheet issued by CMS on Sept. 20 clarifies the point, saying that many have "misinterpreted" a local coverage determination (LCD) that was set to go into effect Oct. 1. The LCD was widely held to mean that Medicare would deny many claims for Group 2 (general use) power wheelchairs.

"Unless they require special seating, people needing a power wheelchair will only receive coverage for what many wheelchair users call a 'junk wheelchair,' a device that has no ability to ride over even the smallest bump and has extremely limited battery power," protested the Medicare Rights Center, an advocacy organization with offices in New York City and Washington, DC, in a statement issued earlier this month, before the clarification.

The LCD does not call for such a blanket down-coding of Group 2 (general use) to Group 1 (light weight) power wheelchairs, assures CMS Office of External Affairs.

"We commend [CMS] for recently issuing a Fact Sheet/Press Release and revision of its Local Coverage Determination in an effort to ensure that Medicare beneficiaries receive the most appropriate power mobility devices to meet their medical needs," said Mike Pfister, president of the New Braunfels, TX-based firm The Scooter Store, in a statement released Sept. 26.

Implementation delay: As result of that change and other, relatively minor tweaks, the effective date for the new codes and LCD will be changed to claims with dates of service on or after Nov. 15, 2006.

Next step: The feds will amend the local coverage determination issued by the DME Medicare Administrative Contractors, making the interpretation official and binding.

"The LCD will be modified to incorporate this and other changes so that there will be no confusion surrounding the basic intent of Medicare's policy," according to CMS.

The clarified LCD will be issued by the durable medical equipment (DME) Program Safeguard Contractor (PSC) Medical Directors, says CMS, adding that the clarified LCD, has been adopted by the DME Medicare Administrative Contractors (MACs).

In addition, CMS says it will issue the long-awaited fee schedule corresponding to the new HCPCS codes "in the near future."

Reminder: Use HCPCS codes E1230, K0010, K0011, K0012, and K0014 as appropriate for PMD claims with dates of service prior to Nov. 15, 2006.

Note: Look for the clarified policy at the following Web sites: www.trustsolutionsllc.com/DRAFT_LCD_Status.asp, www.tricenturion.com, and www.edssafeguardservices.eds-gov.com/providers/dme/lcd.asp.

• Leslie V. Norwalk has been named the acting chief of CMS, federal officials announced Sept. 25. Norwalk, 40, a lawyer who has served in both Bush administrations, is now the deputy administrator at the agency and has served on Medicare's senior leadership team for the past five years.

She will succeed Mark B. McClellan, who announced earlier this month that he is stepping down, effective Oct. 15. One of her first tasks will be overseeing the next enrollment period for the prescription drug benefit, which begins Nov. 15.

• The 2007 Work Plan from the HHS Office of Inspector General adds accuracy of data on the Home Health Compare site to its list of priorities.

Home health outliers, cyclical noncompliance, and the appropriateness of enhanced payments for home health therapy, among other concerns, remain in the plan.

To read the document, go to http://oig.hhs.gov/publications/workplan.html#1.

• CMS should use more recent cost report data in calculating the home health market basket index, says the National Association for Home Care and Hospice.

NAHC made the request in its official comments to CMS on the Aug. 3 proposed rule setting out calendar year 2007 payment rates for Medicare home health services. The proposed rule also contains changes to payment for durable medical equipment (DME) and solicits comments regarding information technology and transparency.

In its comments, the trade group points out several weaknesses in the home health market basket index, according to the Sept. 26 NAHC Report.

Currently, CMS uses cost report data from 2000 to determine the market basket index.

• There's now a companion to the Hobson-Tanner bill in the Senate, thanks to Senators Orrin Hatch (R-UT) and Kent Conrad (D-ND).

The bill, the Medicare Durable Medical Equipment Access Act (S. 3920), aims to ease the effects of Medicare DME competitive bidding for small providers. The House version of the Hobson-Tanner bill (H.R. 3559) has gathered 145 co-sponsors in the House since it was introduced last summer.

• There's no word yet on when CMS might begin recoupment efforts related to OASIS item M0175, a CMS spokesperson tells Eli.

CMS called for the paybacks following a finding by the HHS Office of Inspector General that home health agencies received more than $48 million in erroneous payments in fiscal years 2002 and 2003 related to the OASIS item.

Background: M0175 overpayments come about when home health agencies fail to mark all the correct responses to the OASIS item on prior inpatient stays. If the HHA marks that the patient had a rehab or skilled nursing facility discharge without also marking that the patient had a hospital discharge in the 14-day time period prior to admission, the episode receives an extra point in the service utilization domain.

• CMS has issued a "special edition" MLN Matters article to help providers bill for influenza vaccines.

The article, SE0667, lists a variety of educational resources to ensure that Medicare FFS health care professionals have the information needed to bill Medicare correctly for the Medicare-covered flu vaccines and help promote increased awareness and utilization of the flu vaccine among beneficiaries and providers.

Special Edition article SE 0667 is on the CMS Web site at www.cms.hhs.gov/MLNMattersArticles/downloads/se0667.pdf.

• Sunrise Senior Living announced last week that it completed its acquisition of Trinity Hospice, the eighth largest provider of hospice services in the United States.

Through Trinity, Sunrise has entered the fast-growing hospice care industry that is expected to grow to more than $10 billion in revenue in 2006, the company said in a press release.

• Arcadia Resources, Inc. is opening six more Arcadia Home Medical Supply centers inside Wal-Mart stores in Florida, New Mexico and Texas. The move continues the expansion of Arcadia's direct-to-consumer sales channels. Arcadia acquired the new location from Companion Health Services.