A Spring Mix of News

DMERCs Get New Name and Jurisdiction

    Another of the many mandates in the Medicare Modernization Act (MMA) is about to be implemented. The MMA requires the Centers for Medicare and Medicaid Services (CMS) to put all fee-for-service claims processing up for bid and award contracts by 2011. This means that commercial insurance companies (called contractors or carriers) who currently process claims for Medicare Part A, Part B, durable medical equipment (DME), home care, and hospice and wish to continue the Medicare relationship must submit a proposal and bid. Other commercial insurance companies who wish to participate also may submit proposals and bids. Companies who are awarded the new contracts will be announced in December 2005.

    The new contractors will be called Medicare Administrative Contractors (MACs) rather than Durable Medical Equipment Regional Carriers (DMERCs) and will undergo realignment of some states within the current DMERC Regions. The rationale for this change is that some Regions, particularly Region A and Region B (which process both Part A and Part B claims) operate in 51 overlapping jurisdictions. The new MAC jurisdictions include:
  Region A. Connecticut, Delaware, District of Columbia, Maine, Maryland, Massachusetts, New Hampshire, New Jersey, New York, Pennsylvania, Rhode Island, Vermont
  Region B. Illinois, Indiana, Kentucky, Michigan, Minnesota, Ohio, Wisconsin
   Region C. Alabama, Arkansas, Colorado, Florida, Georgia, Louisiana, Mississippi, New Mexico, North Carolina, Oklahoma, Puerto Rico, South Carolina, Tennessee, Texas, US Virgin Islands, Virginia, West Virginia
  Region D. Alaska, American Samoa, Arizona, California, Guam, Hawaii, Idaho, Iowa, Kansas, Missouri, Montana, Nebraska, Nevada, North Dakota, Northern Mariana Islands, Oregon, South Dakota, Utah, Washington, Wyoming

    For more information about MACs and a map of the new state realignments, go to: https://www.cms.hhs.gov/medicarereform/contractingreform.

GAO: Nation’s Fiscal Policy is Unsustainable

    According to the Government Accountability Office (GAO), the current status of our country’s federal spending and tax programs is so dire that it is “unrealistic to expect that we will grow out of the problem.” Continuing on this path of unsustainable economic policy will cause gradual (if not sudden) damage to our economy, our standard of living, and ultimately, our national security.

    The programs the GAO notes as needing re-examination include defense, Social Security, retirement, technology development, education, healthcare, and homeland security. What is needed, says the GAO, is a fundamental and periodic re-examination of the “base of government, ultimately covering discretionary and mandatory programs as well as the revenue side of the budget.” The problem is simply too big to be resolved by making adjustments to existing spending and tax policies.

    Many policymakers, clinicians, and medical experts believe that both America’s public and private healthcare systems are in crisis, fragmented, uncoordinated, and at risk of jeopardizing the government’s ability to fund other important programs, such as Homeland Security and our country’s overall standard of living. The facts that 45 million Americans do not have health insurance and that access to and the quality of healthcare is unequal in our country are of grave concern in one of the wealthiest countries on the planet. The imminent and immense change in demographics facing our country as the baby boomers reach retirement and increase the need for long-term care can no longer be considered a problem for the future. Rising costs for private healthcare and medical insurance premiums have forced many businesses that want to remain competitive to outsource jobs overseas (where wages and healthcare costs are lower) or to hire part-time rather than full-time workers and minimize cash wage increases and pension costs.

    The GAO recommends that a fundamental re-examination of our nation’s crisis should involve a discussion with the American people about what they want from their government and how much they are willing to pay for it. The entire report is available at: https://www.gao.gov/cgi-bin/getrpt?GAO-05-325SP.

UOA Seeking Information on State Sales Tax on Ostomy Supplies

    The United Ostomy Association (UOA) is attempting to obtain information on states that do and do not charge sales tax on ostomy supplies. Once a more definitive list is obtained, the UOA will attempt to work with state legislators to eliminate sales tax on ostomy supplies in states where sales tax is charged.

    The UOA currently lists Georgia, Illinois, New Mexico, North Carolina, and Oklahoma as states where sales tax is charged on ostomy supplies; and Alaska, Connecticut, Florida, Iowa, Maryland, Michigan, Missouri, Ohio, South Carolina, and Washington as states were no sales tax is charged. The organization is seeking validation of the information they have and additional information on states about which they have no information. Please forward any information about this issue to: https://www.advocacy@uoa.org and put “tax” in the subject line.