Accreditation Deadline Brings Action, Anxiety
HomeCare Magazine
Oct 1, 2009 10:28 AM
WASHINGTON — Just hours before the
implementation of mandatory DMEPOS accreditation, the already chaotic situation
exploded Wednesday with actions on the part of CMS, the Center for Regulatory
Effectiveness and even Congress itself that threw into question the deadline,
onsite surveys and indeed, the whole program.
Based on "an avalanche" of
posts on its Web site that took issue with the accreditation program and said
it would force thousands of providers to close, the CRE announced it was
launching an investigation of the program.
"We are getting a lot of
comments from [durable medical equipment] suppliers, and I think they are
accurate that this accreditation business is going to put them out of
business," said Jim Tozzi, former administrator
of regulatory affairs for the Office of Management and Budget who now heads the
CRE.
The CRE
site is rife with posts — both signed
and anonymous — that detail issues with the accreditation program.
Wrote one provider: "I
am in a rural community and need another 30 days to complete accreditation. I
am strapped due to my small size and few employees, not to mention financial
obligations. The flu virus cut my staff in half this month, which has put us
off schedule. I will have to close if there is any cash flow decrease. I have a
13-year-old business and over 2,000 customers. They will have no local provider
and will suffer the most!"
Other providers said they
were still waiting for onsite surveys months after completing all the
preparation for accreditation.
"Inspectors are
overloaded and unable to inspect everyone," wrote one provider.
"Medicare is dropping provider numbers of everyone who does not make it by
Oct. 1st. Thousands of jobs and small businesses are at stake. Not to mention
the Medicare patients being cared for. Please help us if you can. A three-month
deadline extension could save thousands of jobs."
A Texas provider said she had
applied for accreditation in January and still has not received a final
decision. "We will not have it in time to bill Medicare this next
month," she wrote. "We have lots of capped oxygen customers who no
one will take because they will not get paid. What are these people to do
without their oxygen? We desperately need an extension so we can continue to
serve our patients."
Steve Winter, director of We
the People Patient Rights Group, noted that "not one Medicare patient was
ever notified about this potential disaster in October."
Winter, who fought and won
the right for Medicare catheter patients to receive more frequent sterile
catheters, said his battle will have been for naught if patients cannot get
their supplies because their provider did not make the accreditation deadline.
"There are going to be
patients who won't get their products," he told HomeCare.
"Bottom line," he
wrote on his CRE post, "if any patient does not get a catheter in October
because of this mess, we are instructing the patients to go to the ER … CMS
will have to extend the deadline or promise to honor any retroactive claim or
they will be liable for the disruption of patients' health care. If a patient
has to reuse a urinary catheter and gets infected, everybody loses."
Numerous posts also took
issue with accrediting bodies, detailing poor customer service that included no
acknowledgement an application had been received and no decision letter for
months, and workers ill-equipped to perform onsite surveys.
All of this, Tozzi said, indicated an investigation was in order.
"We don't initiate an
investigation lightly," he said. "We have to have a lot of people —
and people who are affected by [an issue]. The gravity of the public comments
on this convinced us to do it." Even the comments that were anonymous
carried some weight, he said, noting that no provider would want to incur the
wrath of an accrediting body or a government agency.
Tozzi said he has already had numerous
conversations with CMS officials about the accreditation program "and the
CMS view appears to be, 'We told them three years ago
[accreditation was coming].'"
He said he is putting
together a group of former government regulators, such as a former investigator
for the Inspector General's office, to look into the issue. The investigation
will start shortly, but Tozzi said he has no idea
when it will conclude.
"It won't be in time to
get these people reinstated right away," he said about those providers
that are not accredited in time. "It will be in ample time before competitive bidding [implementation on Jan. 1,
2011]."
CRE practices transparent
investigations, he added, and information on the on-going investigation will be
available on the CRE site. He said CMS will get a copy of the final report
(which will also be posted) and it will likely go to the Office of Inspector
General, the General Accounting Office and the Office of Management and Budget.
The White House also monitors the site, he said.
The CRE posts also included
several about an accrediting organization that had been granting accreditation
without onsite surveys, an issue that has been rumored throughout the industry
for some weeks and which CMS is now looking into, according to an agency
spokesman.
Accreditation standards
require unannounced, onsite visits before accreditation can be granted;
however, providers, consultants and accrediting bodies themselves have been
outraged that one accreditor had allegedly been allowed to accredit providers
without doing the site surveys, thus short-circuiting the process for its
clients.
"We're hearing the same
concerns that you are," the CMS spokesperson told HomeCare. "We
have immediately started looking into it. We are taking every complaint very
seriously. I don't have anything to report — we just started hearing the
concerns. We need to dig into it."
It's too early to tell what
CMS might find, he said, but if the agency does uncover any wrongdoing,
"we would be aggressive in our actions."
Meanwhile, even as
stakeholders peppered their CRE posts with pleas for an extension of the
accreditation deadline, pharmacists won a victory in the House of
Representatives Wednesday afternoon when, in a unanimous voice vote, the House
passed a bill that extended the accreditation deadline for pharmacies to Dec. 31, 2009. Reps. Zack Spence,
D-Ohio, and Lee Terry, R-Neb., introduced the bill on Tuesday; late Wednesday
night, a spokesman for the National Community Pharmacists Association said NCPA
was still holding out hope for a companion bill to pass in the Senate that
could be sent on to the president for his signature.
Barring that, said Kevin Schweers, vice president, public affairs, for NCPA, the
organization hopes that CMS will get the message and voluntarily extend the
deadline for pharmacies. Schweers said 50 members of
Congress sent a letter late Tuesday to Acting CMS Administrator Charlene Frizzera noting their concerns about accreditation and also
the $50,000
surety bond
requirement that is to be implemented Friday (Oct. 2).
Saying that the two mandates
"present significant financial obligations" and could cause
pharmacies to drop out of the Medicare program, thus causing access problems
for beneficiaries, the legislators asked CMS to delay both deadlines.
"Congress has already
begun to address these requirements in health reform legislation," the
legislators pointed out, citing H.R. 3200 (the House health care reform bill),
which would "conditionally exempt pharmacies from the surety bond
requirements while also waiving accreditation requirements for certain
products."
The letter added, "The
Senate Finance Committee has also indicated an interest in altering these
regulations."
While passage of the House
bill brought pharmacies and others a glimmer of hope, it also brought up a
question.
"The other side of the
coin is that if they extend the pharmacies, how can they
not extend DMEPOS providers?" asked Sandra Canally,
president of The Compliance Team, one of CMS 10 deemed accrediting
organizations. She pointed out that the House vote was a good thing from the
standpoint of thousands of pharmacies and their beneficiaries. But the
beneficiaries of those DMEPOS providers who could not get accredited in time
will also have access issues, she said.
The CMS spokesperson,
however, while acknowledging the House vote, said he did not foresee a delay of
the deadline for DMEPOS providers.
Yet even in the last days
before the Sept. 30 deadline, providers remained frustrated and confused about
a variety of issues, a fact that did not escape CMS. The agency released a new
version of MLN Matters SE0925 that was "revised to include and
emphasize important information regarding voluntary and non-voluntary
enrollments/terminations," the agency said. Among other things, the
revision encourages companies that are no longer Medicare providers to alert
their patients as soon as possible.
But the article was too late
for some. For the last week, numbers of providers, many of whom have been
waiting to learn of their accreditation status, have reportedly been trying to
withdraw their Medicare billing numbers voluntarily effective Oct. 1 because
they feared they would not be accredited in time.
Accreditors, who said they
continued to work around the clock to get as many providers through the process
as possible, said they had also advised some providers that they wouldn't make
the deadline and they should voluntarily withdraw from Medicare until their
accreditation had been secured.
"We had quite a few
providers that signed up in September," Canally
said. Some were prepared, their onsite surveys were completed and they made the
deadline, she said. Others weren't ready and were encouraged to withdraw
voluntarily from the Medicare program.
Under CMS rules, unaccredited
providers who did not submit a voluntary termination of their Medicare billing
number risk termination by the National Supplier Clearinghouse and will then
not be able to reenroll for at least a year. Those who
voluntarily withdrew their numbers can apply to reenroll once they are
accredited, the agency has said.
However, Waterloo, Iowa-based
service group VGM reported that some providers filed to withdraw their numbers
only to discover that their accreditor had approved their accreditation status.
The NSC, however, had already processed their voluntary withdrawal request and
they had been terminated. VGM officials took the issue to CMS and were later
told by the NSC that those providers who did receive accreditation by Oct. 1
could withdraw their termination request by submitting the appropriate sections
of an updated CMS-855S form.
While it is too early to
gauge the fallout from the accreditation program in terms of beneficiary access
and the number of providers that dropped or were dropped from the program, it
claimed at least one casualty on Wednesday, according to the Accredited Medical
Equipment Providers of America.
"All Florida Medical
Supply in Delray Beach [Fla.] is still listed as accredited through July 31,
2010, with the Accreditation Commission for Health Care (ACHC), but they
recently closed their doors, leaving a staff of nine unemployed, and resigned
from the Medicare program," reported AMEPA President Rob Brant. "This
coming Monday, Oct. 5th, the former AMEPA member will have their remaining
assets sold in an absolute auction to pay back creditors."
"'I spoke to the owners
a few months ago about their potential closing,' said Jack Marquez, vice
president of AMEPA and co-bidder in the first Round 1 with All Florida Medical
Supply in the All Florida Network.
"We bid together in a
network … in 2007," Marquez added. "Most of the members of the
network were located in Miami-Dade County, and All Florida Medical had a
12-year history of providing quality service and products to cover Palm Beach
County. Their client base was almost 100 percent Medicare, and with the 36-month
cap in oxygen, 9.5 percent reduction in reimbursement, increased ongoing
documentation requirements and mandatory surety bond, it is understandable why
they and so many other
companies are going out of business."