The home health proposed rule from the Centers for Medicare & Medicaid Services (CMS) — published July 2 in the Federal Register — contains Medicare competitive bidding program changes that American Association for Homecare (AAHomecare) CEO/President Tom Ryan has described as “an asteroid heading straight to planet DME [durable medical equipment].”
But the proposed rule also contains extensive changes to accreditation policies for durable medical equipment, prosthetics, orthotics and supplies (DMEPOS) — changes that could cause additional upheaval for providers and accrediting organizations alike.
In AAHomecare’s Aug. 6 webinar examining the proposed rule, Cara Bachenheimer, AAHomecare’s general counsel, Brown & Fortunato, said, “There’s a significant change to the accreditation requirements. From a supplier perspective, one of the proposals is to change the mandatory surveys from every three years to every year.”
That would require every location of a provider’s DMEPOS business to be surveyed every year.
“As part of its proposed rule, CMS is always required to do a regulatory impact statement, which talks about the costs that are imposed on the regulated industry,” Bachenheimer added. “And they are estimating that between all eight accreditation organizations, they would have to hire only 24, collectively, additional employees to actually administer those surveys.”
While that number already sounds small for organizations effectively being required to triple their workload, Bachenheimer said that estimated headcount does not include non-employees who are typically contracted to administer those surveys. “They don’t count the contractors as part of their regulatory impact statement,” she said.
“I know the accreditation organizations are all working on comments, as well, and have had a lot of conversations about the additional impositions on the accreditation organizations,” Bachenheimer added.
CMS is accepting public comments on the proposed rule through the end of the business day, Eastern time, on Aug. 29.
Quality standards or law enforcement?
On top of requiring accreditation organizations to renew DMEPOS suppliers’ accreditation yearly, CMS is in effect changing the very nature of the work done by the organizations, Bachenheimer said.
“The accreditation organizations are enforcing the Medicare quality standards,” she said. “What CMS appears to want is to turn them into law enforcement officials and to look at fraud, waste and abuse, and potential over-utilization, which is a completely different role than the accreditation organizations have traditionally had.”
Mina Uehara, AAHomecare’s senior director of regulatory affairs, added, “I do want to highlight that CMS also asks whether accreditation organizations should conduct surveys in between those initial surveys and the re-accreditations. [CMS wants] to use this as a fraud tool, as well — so, unannounced surveys in between those one-year-mark surveys.”
Ryan added that the proposed rule estimated that switching to annual accreditation could cost suppliers an additional $128 million.
“And that’s probably a low estimate, we know,” Bachenheimer said.
“It’s very difficult to do, considering how much it takes for a supplier to prepare for a survey,” Uehara said. “Not only that, but also for the accreditation organization, as well.”
