Moving the HME Industry Forward

Legislative/Advocacy

CMS Denies Problems, Makes Major Adjustment in Hawaii


April 21, 2014

WASHINGTON, DC – This week in Hawaii, CMS made a notable exception to the bidding program. Despite the agency’s claims that the bidding program has not harmed patients, the unintended consequences of implementing the program in the Honolulu bidding area have been disastrous.

As reported in AAHomecare’s Wednesday in Washington notice to members, only 13 of the 97 providers selected are located in the state of Hawaii. There is no same day or overnight express shipping option to Hawaii, so mainland providers servicing oxygen, continual feeding, and other life-sustaining equipment cannot get equipment or replacement parts to the islands faster than 2-4 days. The typical wait time for a physician-ordered Medicare hospital bed or wheelchair is 4-8 weeks.

On top of this, contract winners on the U.S. mainland have not been able to subcontract with local providers because the prices are below the cost of supplying equipment once shipping costs are taken into account.

The Healthcare Association of Hawaii (HAH), a member of AAHomecare’s State Leaders Council, and the Hawaiian congressional delegation were able to convince CMS of the severity of these problems. In response, the agency has awarded contracts to Aloha Medical and American Home Care Systems, both of which are local providers physically located on the island of Oahu.

Overwhelming Number of Negative Comments for Bidding Program Proposed Rule
AAHomecare reviewed the comments submitted in response to CMS’ proposed new rules for the bidding program and found that the overwhelming majority are critical of the rules. An array of providers, manufacturers, and trade groups as well as clinicians and patient advocates sharply oppose the rules, with some comments stating outright that the program is devastating to Medicare patients and providers in rural communities. Read all of the comments at regulations.gov.

Denied Medicare Claims Overturned Following OMHA
WATERLOO, Iowa – February’s OMHA Appellant Forum in Washington, D.C., afforded VGM members the opportunity to question Chief Judge Nancy Griswold about the tumultuous DME audit process. Some members, who had submitted denials they thought were inappropriate or inaccurate in advance of the event, are experiencing better outcomes.

Of the claims submitted, 70 percent of them were overturned fully or partially in favor of providers, indicating that the original denials were made in error.
“C2C Solutions was willing to look over the denials that were made in error,” said Peggy Walker of VGM’s U.S. Rehab. “The errors were technical errors that were reviewed inappropriately by the first two levels of appeals.”

Save the date – AAHomecare’s Washington Legislative Conference is May 6-8

WASHINGTON, DC – It’s time to exercise your right to petition the government. Before you arrive in Washington, D.C., AAHomecare will work with you to schedule the right appointments. Top experts will help you understand the details of the key issues during a day-long series of seminars at the Omni Shoreham hotel. AAHomcare will also provide tips on the best ways to establish working relationships with members of Congress, plus give you handouts to leave behind in Hill offices after your appointments. Click Here to Register for the Conference.

Source: Wednesday in Washington from the American Association for Homecare