Editor's Note

Does it Take a Disaster?

CMS's moves last month to support hurricane-stricken providers, patients leaves me wondering.

The scale of devastation wrought by hurricanes Harvey, Irma and Martha is hard to fathom. When you look at the footage of a completely flooded Houston, or Puerto Rico without water, or entire Caribbean islands swept clean, as though some angry titan from ancient Greece had swept his hand from one side to the other, the enormity of the situation really starts to sink in: there is no phone or Internet, there are no passable roads, there is no healthcare, in some cases there is no food or water.

A close friend is living through this. His town of Rockport, Texas sat right in ground zero when Harvey made landfall. Miraculously, his home was spared with only minor damage, but the town fared far worse. All communications were ripped apart, the roads were rendered impassable, and major buildings such as the high school were so blasted that they’re now complete write-offs. More than a week afterward, a gas station, a grocery store and a Walmart were functioning, but only on a cash basis.

These places will have a rough go of it, my friend tells me. He’s a veteran of major hurricanes. He previously went through Gilbert when he lived in Jamaica, and he said it took more than two years for the island to recover.

CMS Took Notice

But one thing that did spring into action was the HME industry. For instance, in the aftermath of Hurricane Harvey, as Houston, the Texas Gulf Coast and Louisiana grappled with floods that killed dozens and displaced more than 30,000 people, HME providers responded to the tragedy by providing needed medical equipment and services to patients impacted by the disaster. And the same thing happened in the wake of Hurricane Irma, with providers rushing to help ensure their clients had equipment and supplies.

HME can mean the difference between life and death in some cases. The need for medical equipment — and life-preserving oxygen delivery systems in particular — was obvious. Some people would literally die without oxygen devices.

That’s why, CMS moved to make it easier for beneficiaries to get replacements for DME lost or damaged in the storms by waiving the usual mandatory face-to-face, physician’s order and medical necessity documentation typically required for providers to supply those items. Also CMS extended the deadline to provide notification regarding any subcontracting arrangement from 10 days to 30 days.

That’s terrific, but at the same time, the industry is having to fight a legislative battle to pass a law requiring CMS to spare accessories for manual CRT chairs from bid rates. Remember, we’re not talking about cup holders; these are seating and positioning devices and similar upgrades that enhance the therapeutic benefit of a wheelchair.

Moreover, CRT accessories were supposed to be part of the CRT carve out. When CMS decided to make an end-run around that legislative language and still include accessories in competitive bidding, Congress passed a law telling them to carve out the accessories, too. Then CMS made another detour around that bill’s language saying that it only applied to power CRT. Now Congress is working to pass another law stipulating that manual CRT accessories be carved out. We’re talking about wheelchair parts that users will need their entire lives. Why is CMS so bent on making their access to those so difficult?

I’ll be closely watching how the manual CRT bill fares in the House and I hope to see a companion bill launched in the Senate, as well. I’m also hoping that we’ll see more progress made in regard to the Ways and Means Committee’s Medicare Red Tape Relief Project, which aims to cut more burdensome regulation from the process. You can read more about that in our annual Editorial Advisory Board roundtable, "Shining a Light." Hopefully there will be updates on both at the American Association for Homecare’s Washington Update during this year’s Medtrade (Oct. 23-25 in Atlanta). Make sure to watch HMEB’s Live from Medtrade page for live reports.

But for now, when you pull back and compare those two events — the hurricane waivers and the manual CRT fight — the juxtaposition makes your head spin. In one case, CMS does everything it can to ensure patients get DME, and in another case it does everything it can to reduce access to DME. The only difference is two hurricanes of historic scale. I guess CMS will recognize the value of a DMEPOS benefit that comprises a paltry 1.8 percent of its budget if it is pushed. It just takes a major disaster to make that happen.

This article originally appeared in the October 2017 issue of HME Business.

About the Author

David Kopf is the Publisher and Executive Editor of HME Business and DME Pharmacy magazines. Follow him on Twitter at @postacutenews.

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