Home Health & Hospice Week

Latest Open Door Forum also highlights quality standards, drug formularies.

Don't try to pin down a date for when the Centers for Medicare & Medicaid Services will release the final rule on competitive bidding for durable medical equipment, because the agency isn't offering any specifics yet.

Participants in the Dec. 15 Home Health, Hospice and DME Open Door Forum peppered CMS with questions about its timeline for impending initiatives, including the final rule on competitive bidding.

When pressed, CMS project officer Mike Keane would say only that CMS is working on the final clearance package for bidding and that the rule would be published "very soon."

The agency is still "trying to fine-tune" the policies, Keane reported. Once the rule is published, CMS will hold a meeting of the Program Advisory & Oversight Committee to offer "some background" on the policy, Keane said.

Look For Quality Standards In Spring

CMS hopes to release the quality standards for DME suppliers in the spring of 2006, Linda Smith of CMS said in the forum.

CMS is sifting through the comments it received on the proposed standards, Smith noted. The agency didn't have to take comments, she pointed out, since Congress gave it authority to set the standards through program instructions, which are not subject to comment.

However, since the standards were new to the industry, Smith said, "we did think the issue was significant enough that we did allow for this process."

CMS from this point on will be treating the standards like a garden-variety regulation--which means no additional comment period. But the agency will release a comment-and-response document.

Part D To Offer Coverage Where Part B Doesn't

Meanwhile, CMS is not shifting Medicare Part B drugs to the Part D prescription drug benefit program.

That was the assurance Craig Miner of the CMS Center for Beneficiary Choices offered during forum. He was responding to a question raised during November's forum by a caller who asked why Part B drugs were showing up on Part D formularies.

In most cases, Medicare Part B only covers a limited number of drugs depending on the patient and setting, Miner noted. For instance, Part B covers drugs that are not usually self-administered and that are obtained incident to a physician's service. But next year, if the patient were to go to a pharmacy and get the same drug, Part D would cover it.

In another example, Part B covers albuterol solutions in the home setting under the DME benefit. However, there's no DME benefit in long-term care, so when an individual's Part A skilled nursing facility stay ends, Part B does not pick up coverage of those solutions--but Part D will in 2006, Miner noted.

"Part D will provide coverage in those situations when Part B does not," Miner said. "Nothing is shifting from Part B to D."