NAIMES, = National Association of Independent Medical Equipment Suppliers

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HOW TO CONTACT YOUR MEMBER OF = CONGRESS

Oxygen--Repeal = the Cap=20

HR2373 (HOPP Act of 2009) Talking=20 Points

Sample Supplier Letter to House of=20 Representative Member to Sign HR 2373 (HOPP Act of=20 2009)

NAIMES Submits Comments to CMS on = Oxygen Cap=20 Rule
NAIMES submitted a 6 page = document to=20 CMS containing comments collected from the NAIMES = membership=20 and Board. These were consolidated into a series = of=20 points in an attempt to show CMS the problems and = concerns=20 with the final rule on the post-cap oxygen policy. =

December 23 Transmittal Outlines = Billing=20 Criteria For Capped Oxygen =

In Transmittal 421 dated December 23, 2008, CMS = published=20 detailed criteria for billing and payment of oxygen = claims=20 after the cap starts on January 1, 2009. In = addition to=20 setting the payment amounts for 15 minute units of = labor, the=20 instructions include specifics for supplier=20 responsibility to patients post-cap, and there are no = breaks=20 for suppliers in the policy directed to the DME = MACs. =20 The document contains specific instructions relating = to=20 modifiers, suppliers, oxygen contents, maintenance and = servicing, repairs, and repeal of ownership transfer. =

NAIMES O2 Talking Points =20 11.20.08

Oxygen Patient Letter to = Congressman---Oxygen=20 Cap

Supplier Letter to Oxygen = Patients---Oxygen=20 Cap

Oxygen Cap Press Articles =

Oxygen Letter to Congressman Pete = Stark =20 11.7.08

NAIMES Communicates to CMS the = Industry's=20 Immediate Need for a Capped Oxygen=20 Policy October = 17,=20 2008

NAIMES Letter to CMS' Kerry=20 Weems = October 15,=20 2008

NAIMES Letter to CMS' Kerry=20 = Weems August=20 21, 2008

&n= bsp; =20

&n= bsp; &nb= sp; =20 Oxygen Policy A Disaster For Suppliers!!

After three years waiting for the post = 36-month=20 capped oxygen policy, the DME industry received a = stark dose=20 of CMS unreality. In just 22-pages of the 1459 = page=20 final rule for the Medicare Physician Fee Schedule = (MPFS) for=20 calendar year 2009, CMS took the mandate of Congress = in the=20 DRA 2005 and MIPAA 2008 to the very extremes. = Most=20 devastating was that the repeal of the transfer of = ownership=20 by Congress was used by CMS to essentially say to = oxygen=20 suppliers, "You took the patient, now you have to = serve them=20 after the cap for free regardless of what they need or = where=20 they go."

Every DME stakeholder has issued statements = deriding the new policy, but little can be done unless = Congress acts during the lame duck session after the=20 election. NAIMES has written to key legislators = asking=20 for relief by repealing the cap policy passed by = Congress in=20 2005. "We are asking that the provisions of HR = 621 be=20 included in any economic stimulus package that is = brought to=20 the floor of the House and Senate." stated Wayne = Stanfield,=20 NAIMES President. NAIMES has previously = contacted House=20 Ways and Means Committee members asking for help in = repealing=20 this bad public policy. Since a proposed = economic=20 stimulus package will likely be the only bill voted on = before=20 this year ends, the industry has only one chance to = stop the=20 rules from taking place.

HR 621 was introduced January 2007 by Rep. = Tom=20 Price of Georgia and has 143 co-sponsors. The = Senate=20 companion bill, S 1484, introduced by Senator Pat = Roberts in=20 May 2007 has 11 co-sponsors. This legislation is = to=20 repeal the provisions of the DRA 2005 and restore = payments for=20 home oxygen therapy to what was in place prior to = passage of=20 the DRA 2005. "Possibly the only chance we have = to end=20 the pending crisis for patients and suppliers is to = insure=20 that a repeal of the cap is passed before January 1, = 2009,"=20 notes Stanfield.

The presumption that suppliers must = actually=20 support a piece of equipment for two years without = payments=20 equates to telling any other healthcare provider that = they are=20 totally responsible for a patients care for two years = after an=20 initial service such as a hip replacement or = installing a=20 pacemaker. The gross error in that judgment is = that this=20 equipment sustains the life of the patients for which = it was=20 prescribed by a physician. It is ridiculous to = consider=20 that a payment cap can be placed on equipment that = delivers=20 the very breath keeping these frailest of seniors at=20 home. Capping this FDA regulated drug is the = same as=20 capping payments for medications that a patient = depends on to=20 manage other disease states such as diabetes, = congestive heart=20 failure, or hypertension.

The assumptions and statements contained in = the=20 policy released by CMS clearly shows that they have no = concept=20 of what home oxygen therapy means or what service is = required=20 of oxygen providers. Some of the rules are so = ridiculous=20 they would be laughable if they were not so = frightening. =20 Consider the fact that the policy states an oxygen = supplier is=20 responsible for providing oxygen to a patient that = moves or=20 travels, either directly or by arranging with another=20 supplier. Such a requirement is completely=20 unreasonable. The east coast provider whose = patient=20 moves to the mid-west in the 38th month would = certainly not be=20 able to meet the patient's needs themselves and would = have to=20 pay a subcontractor out of pocket without any = reimbursement=20 for the next 22 months. The ongoing cost of the = service=20 portion of providing home oxygen therapy is documented = by=20 studies as being 78% of the fee paid by = Medicare. The=20 ludicrous assumption that because a supplier was paid = for=20 three years they can support a patient for the next = 24-months=20 without payment shows the complete disregard for = reality, the=20 desire of CMS to further broadly punish the DME=20 industry.

The policy contains provisions that will = disrupt=20 the home oxygen therapy to an estimated 200,000 to = 350,000=20 Medicare oxygen patients including those enrolled in = Medicare=20 Advantage plans. The real crisis is for = suppliers who=20 are left without recourse at this point in the = process. =20 The policy clearly states that the supplier MUST = continue to=20 provide the equipment for no additional payment. = With=20 the repeal of the transfer of ownership, suppliers = have no=20 ability to collect any payment from the patient. = Since=20 the equipment remains the property of the supplier, = the rules=20 essentially take any patient responsibility out of the = equation. Further, patients cannot be expected, = nor will=20 they have any incentive to write or call Congress = since the=20 policy mandates that suppliers must provide all = support,=20 repair, supplies, on-call, and routine maintenance to = them=20 without charge (except for $30 every 6-months for=20 2009).

With the mandates of this policy, NAIMES = believes=20 that hundreds of suppliers will simply opt out of = oxygen=20 service and some may ultimately go out of = business. Good=20 and sound suppliers will be forced to choose their = conscience=20 over good business and will serve patients without = payment=20 until they cannot sustain their businesses any = longer. =20 No supplier will accept an existing patient for = service after=20 the cap, or even within a few months before. The = most=20 fearful part is that suppliers who make good decisions = for=20 their business will be punished by CMS for failing to = serve=20 patients without realizing the full ramifications of = their=20 choice. Suppliers are trapped between being a=20 compassionate business and staying in business. =20 Suppliers who end service will risk the wrath of = referral=20 sources and patients, as well as Medicare. All = suppliers=20 are urged to carefully asses any decision being = considered=20 relating to this policy to minimize their exposure and = risk.

Every supplier MUST get involved NOW. = For=20 once, every oxygen supplier, small or large, public or = private=20 is in the same predicament and must take action. = Suppliers must call their Representatives and Senators = IMMEDIATELY and ask that the oxygen cap be = repealed. Ask=20 that HR 621, either as a stand-alone bill, or as an = amendment=20 to the proposed economic stimulus bill, be passed as = soon as=20 possible. Be persistent with your calls. = Time is=20 of the essence so write only if you fax or email your=20 letters.

With the repeal of the transfer of = ownership, the=20 2-month notice required by the November 2006 = regulations no=20 longer applys since the equipment remains the property = of the=20 supplier. Unless a new supplier agrees to take a = patient from=20 the original supplier, the original supplier is = responsible=20 for serving the patient until a new cap period can = begin after=20 5 years. There are no provisions releasing the = original=20 supplier from responsibility, nor one giving the = supplier the=20 ability to opt out of providing the service if no one = else is=20 willing to take the patient. This is based on the = belief by=20 CMS that the supplier has received adequate payment = during the=20 three year cap period to sustain them during the = subsequent=20 24-months.

Changing from assigned to=20 non-assigned is permissible, but will only allow a = supplier to=20 charge for contents at the customary price. The = supplier=20 cannot charge for any covered service or equipment = after the=20 cap, regardless of assignment of benefits.
Without = the=20 intervention of Congress, there is likely to be little = relief=20 from these rules and certainly none related to = payments for=20 service, despite vague language in the MIPAA 2008 law = to the=20 contrary. While a mention of ongoing payments = was=20 included in HR 6331, CMS clearly interpreted this to = mean no=20 payment for the ongoing service to the patient. =20 Throughout the policy, CMS persistently writes that = they must=20 protect the beneficiary from the very supplier they = rely on=20 for their service. It assumes the industry is = riddled=20 with bad players waiting for an opportunity to cash = in, a=20 classic example of being presumed guilty before the=20 trial.

The ball is now in the court of the = thousands of=20 oxygen suppliers around the country. NAIMES = urges every=20 supplier to take positive and proactive steps to reach = Congress immediately after the election. With = Congress=20 expected to be called back into a lame-duck session = after=20 Veterans Day, any chance of action will depend on the = volume=20 of calls that reach their offices.

DO NOT WAIT FOR SOMEONE ELSE TO ACT! =20

NAIMES, VGM, INVACARE, AAHOMECARE AND = OTHERS WILL=20 BE TAKING ALL POSSIBLE STEPS TO REACH A SOLUTION, BUT = ONLY=20 SUPPLIERS CAN ACTUALLY AFFECT CHANGE BY MAKING YOUR = FEELINGS=20 KNOWN TO WASHINGTON. CONGRESS IS AT HOME AND CAN = BE=20 REACHED AT THEIR HOME DISTRICT OFFICES AS WELL AS IN=20 WASHINGTON. CONTACT INFORMATION CAN BE FOUND ON = AT=20 http://www.dmehelp.org/ OR CALL THE CAPITOL = SWITCHBOARD AT=20 202-224-3121.

NAIMES =3D COMMITTED + AGGRESSIVE + = PROACTIVE +=20 GRASSROOTS

=20

=A9 NAIMES | 5037 Halifax Road, Suite L7, PO = Box 669,=20 Halifax, Virginia 24558
434-572-9457 | Fax 434-572-6889 | Toll Free=20 877-4DMEHELP | yourfuture@dmehelp.org
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