Home Health & Hospice Week

Comment period ends Sept. 25.

A proposal to reshape the way Medicare pays for oxygen and oxygen equipment has oxygen suppliers reshaping their own coalitions.

The Centers for Medicare & Medicaid Services published a proposed rule regarding the changes in Medicare reimbursement for oxygen and oxygen equipment in the Aug. 3 Federal Register. At press time, supplier representatives were still poring over the rule, according to Joe Lewarski of Inogen in Santa Barbara, CA.

Almost immediately upon the release of the rule, a group of 11 respiratory providers and manufacturers joined together in a coalition called the Council for Quality Respiratory Care (CQRC). The group aims to "facilitate a deeper understanding of the clinical and operational complexities associated with the provision of home oxygen therapy," according to a news release announcing the group's formation.

Read The Fine Print

The proposed rule is the first step in implementing a provision of the Deficit Reduction Act of 2005, which calls for limiting to 36 months the total number of continuous months which Medicare will pay for oxygen equipment. After that, suppliers are to transfer the title of the equipment to the beneficiary.

In addition, the DRA mandates that Medicare continue to make monthly payment for furnishing oxygen contents after the title transfers to the beneficiary.

Big hit: The new rule proposes new classifications and payments for all home oxygen therapies, including a new category for oxygen-generating portable equipment, such as portable concentrators and home transfilling systems.

Under the old payment rules, payment for oxygen concentrators used for stationary equipment purposes would have continued at approximately $200 per month for the entire period of medical need.

Outcry: In its first public statement, CQRC expressed disappointment with CMS' proposal to change oxygen categories and fees.

"We are concerned that [the] proposal ... to overhaul Medicare's payment system for home oxygen therapy will have a negative impact on providers' ability to assure access to the level of care and services beneficiaries expect and deserve," says Peter Kelly, CEO of Pacific Pulmonary and CQRC chairman.

Beneficiary advocacy groups are monitoring the proposed rule. The plus side for beneficiaries includes no longer owing co-payments beyond the 36-month period, according to the Center for Medicare Advocacy. But the rule could also bring risks to beneficiaries, says Judy Stein.

The reduction in costs to the beneficiary are good, she says, "unless it means beneficiaries will end up owning outdated equipment, can't get it repaired, or find that the new payment system is somehow so against provider interests that people end up having problems gaining access to equipment that they have been able to rent," Stein tells Eli.

Note: To see the proposed rule, go to www.cms.hhs.gov/HomeHealthPPS/downloads/CMS-1304-P.pdf.