Regulatory Updates for Summer
Home Medical Equipment Accreditation
The Medicare Modernization Act (MMA) mandated that an authorized accreditation group accredit providers of home medical equipment (HME). The Centers for Medicare and Medicaid Services (CMS) is slated to finalize these accreditation standards by the end of this summer. Because an estimated 60% to 70% of the hundreds of HMEs are not accredited, massive numbers of providers will need to be accredited in very short time. In order for providers to participate in the Competitive Bidding Program, they must meet CMS accreditation standards. The Healthcare Quality Association on Accreditation (HQAA) has been formed to accredit the HME industry in accordance with MMA requirements. It is anticipated that the process will be Internet-based.
Region D DMERC Changes Name
On May 24, 2005, CIGNA HealthCare Medicare Administration, the Durable Medical Equipment Regional Carrier for Region D, changed its name to CIGNA Government Services, LLC. The company believed a name change would better represent the nature of its business as a contractor for Medicare Part B and durable medical equipment for government healthcare plans. The name change will be phased in over an extended period of time but will be evident on the DMERC Region D website and publications.
DMERCs Offer Ostomy Patients More Choice
All four DMERC regions have confirmed they will now cover and reimburse a mixture of two pouch types within the same month. Under the previous policy, physicians could write orders for two types of pouching systems (for example, drainable pouches and closed-end pouches) but suppliers could only provide one type of pouch per month. Medicare beneficiaries could purchase drainable pouches one month and closed-end pouches the next month.
Medicare now will cover and reimburse half of the Usual Maximum Quantity for each pouch type within the same month. For example: the Usual Maximum Quantity for closed-end pouches and drainable pouches is 60 and 20, respectively. Now, beneficiaries can purchase 30 closed-end and 10 drainable pouches (half of each Usual Maximum Quantity) within the same month. This provides beneficiaries with an ostomy more freedom and choice regarding their individual management preferences.
National Guideline Clearinghouse: Care of Contact Dermatitis
The British Association of Dermatologists has developed guidelines for the assessment, management, and treatment of contact dermatitis. These guidelines were recently published on the National Guideline Clearinghouse (www.guideline.gov) website.
The guidelines discuss the various classifications of contact dermatitis, the procedures for patch testing, and the need for formal training in patch testing reading and interpretation. Specific recommendations for the treatment of irritant contact and allergic contact dermatitis also are included. The guidelines are available at: https://www.guideline.gov/summary/summary.aspx?view_id+1&doc_id=6627.
Medicare Appeals Process to be Accelerated and Streamlined
The Medicare Appeals Process has been criticized for being long and tedious. Using technology such as video teleconferencing for electronic hearings, the Department of Health and Human Services hopes to speed up the process, making more efficient use of technological and human resources.
The Department has access to teleconferencing services in more than 1,000 cities across the country. In order to decrease the burden on elderly or disabled beneficiaries who find traveling difficult, an Administration Law Judge (should the services be required to settle an appeal) will travel to a location convenient to all parties. Video teleconferencing technology (VTC) can be used to hold electronic hearings.
Outcome Reports for Home Health
The Center for Health Services Research at the University of Colorado is under contract with CMS and has published extensive outcomes reports for home health care. The reports list many metrics by which patient improvement was measured, especially as they relate to continence, activities of daily living, and other measurable outcomes. The reports can be viewed at: https://www.qualitymeasures.ahrq.gov.
