Home Health & Hospice Week
Wheelchair Suppliers Call For Immediate Guidance
Clear, consistent documentation requirements another must, trade group says. Industry and beneficiary advocates are keeping up the pressure on the Centers for Medicare & Medicaid Services to get its wheelchair coverage policy in line.
In December, CMS announced that rather than issuing new coverage guidance outright, it would put the coverage policy through the National Coverage Determination process (see Eli's HCW, Vol. XIII, No. 45, p. 355). CMS took comments on the NCD until Jan. 14.
The Power Mobility Coalition calls on CMS to issue immediate interim guidance implementing the functional-based ambulation standard instead of the old bed- or chair-confined standard. "Immediate interim guidance to contractors is required to ensure that all beneficiaries with limited or compromised mobility will have access to mobility products and services," PMC insists in its Jan. 14 comment letter.
A Clinician Task Force of the Coalition to Modernize Medical Coverage of Mobility expresses dismay that final coverage guidance could be six months off. "We were expecting coverage policy guidance by the end of 2004," says physical therapist Laura Cohen, co-coordinator of the task force, a group of physical and occupational therapists and other specialists in seating and wheeled mobility.
PMC also calls for: clear and consistent documentation requirements; keeping the fitting and furnishing of power wheelchairs open to non-clinicians; elimination of the in-the-home requirement for wheelchair coverage.
The task force also urges CMS to drop the in-the-home requirement, plus: recognize basic mobility as a functional activity; specify clear requirements for medical necessity documentation; link levels of beneficiary function to the specific equipment (HCPCS codes); and specify all key "terms of art" to avoid misinterpretation of the coverage criteria.
More information is available online at www.cliniciantaskforce.org.
More and more Americans are expressing a desire for home care, Genworth says in a release. "As 77 million people approach retirement, growing life expectancy is stimulating demand for long term care and, consequently, driving up costs for nursing homes, assisted living, and home care," says Buck Stinson, president of Genworth Financial Long Term Care.
Instead of furnishing home care through Area Agencies on Aging as it used to do, Florida is running the home care program through various managed care entities, the paper reports. That means beneficiaries might see their care scrimped on - and providers might see rock-bottom rates for that care.
"We want to work together," Linda Levin, executive director of Jacksonville's AAA, told the paper. "We don't want to see this go completely over to managed care."
The federal grant that funds Project OUT will end Sept. 30, so the Administrator for the Wyoming Department of Health's Aging Division has asked state lawmakers to consider funding the program from Oct. 1 through June 30, 2006, at a cost of $280,000, AP says.
The program is projected to save the state $670,000 in Medicaid dollars during its three-year grant period by keeping residents out of nursing homes.
In one case, the state wants to recoup $38 million from the Visiting Nurse Service of New York. But an appellate court has given the VNS the right to a hearing, in which the agency can prove it exhausted all other remedies before billing Medicaid, the newspaper says.
New York is trying to recover nearly $500,000 in payment from Catholic Health System's home care unit, and $319,000 from Episcopal Church Home. The state had been recouping the disputed payments by withholding current Medicaid reimbursement, the paper says. The HHAs are seeking hearings in court as well.
Mile Bluff Clinic in Mauston, WI, faces losing between $100,000 to $150,000 this year on drugs, Director of Compliance Mary Peterson told CMS' Physician Open Door Forum on Jan. 12. Obtaining drugs at anything close to the new payment levels is proving impossible, she said.
In response, CMS officials said they've already adjusted some drug payments upward due to reports like hers.
In May 2004, CHRISTUS Health decided to consolidate all of its home health units system-wide (in Texas and Louisiana) under one entity, it says.
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Wheelchair Suppliers Call For Immediate Guidance
Clear, consistent documentation requirements another must, trade group says. Industry and beneficiary advocates are keeping [...]
