Beneficiaries receive separate process.
An overhauled method of issuing national coverage decisions could clear some of the murk from the process of securing Medicare coverage for new products and services. The Centers for Medicare & Medicaid Services updates the process it will use to issue Medicare NCDs in a final rule published in the Sept. 26 Federal Register. Among the new policies is a separate process for beneficiaries who need an item or service that isn't currently covered. CMS says it will issue NCDs in such cases in 90 days. The rule also clarifies what elements are required to make a formal request for an NCD and outlines what CMS will consider in making its determinations. "Our goal is to make the latest advances in medical care available to Medicare beneficiaries more rapidly, while making evidence-based decisions that safeguard the health and safety of patients," says CMS Administrator Tom Scully. The rule, which goes into effect Oct. 27, is available online at
www.access.gpo.gov/su_docs/fedreg/a030926c.html. Home health agencies will see some immediate survey changes thanks to the Home Health Compare Web site that will compares agencies' patient outcomes nationwide starting later this month. In a Sept. 11 letter to state survey agencies, CMS tells them to update HHAs' demographic data (name, address, phone number, services offered) upon request. Currently, that data is updated only during surveys. HHAs that want information changed must contact their state OSCAR/ASPEN coordinator, who can be located at
www.medicare.gov/hhcompare/search/related/oscaraspen.asp, the letter says. States could start paying for more home care services, if CMS gets its way. A Sept. 17 letter urges state Medicaid directors to adopt more "Money Follows the Person" programs, in which long-term care funding goes toward home- and community-based care, not just nursing home care. CMS praises Oregon, Indiana and Arizona for their programs that keep beneficiaries out of institutions. The letter, which also promotes self-directed care programs, is at
http://cms.hhs.gov/states/letters/smd91703.pdf. Durable medical equipment suppliers may see more enforcement of skilled nursing facility bundling in the New Year. CMS tells DME regional carriers to turn on their automated processing of the unsolicited response for SNF consolidated billing claims Jan. 1, 2004, according to Sept. 26 Trans. No. 1819. Remark code N121 tells suppliers "Medicare Part B does not pay for items or services provided by this type of practitioner for beneficiaries in a Medicare Part A covered skilled nursing facility stay." Appeals for certain DME items are about to change. A written order prior to delivery is required for: pressure reducing pads, mattress overlays, mattresses, and beds; seat lift mechanisms; TENS units; and power operated vehicles, CMS notes in Sept. 12 Trans. No. 48. DMERCs may require a written order prior to delivery [...]
