CMS’ Announcement of Round 1 Recompete
The Round 2 product categories comprised about 200 codes, while the Round 1 “recomplete” product categories have more than 300 codes. Despite this increase in the number of overall codes, CMS cut down the number of total product categories from nine to six, basically grouping numerous products into larger categories.
Cara Bachenheimer of Invacare’s government relations says that CMS’ move is clearly geared to accommodate a larger provider who will be able to provide a full range of everything, along with the option to subcontract, which is not a financially viable model. Additionally, some product categories could create a problem to providers like respiratory and external infusion pumps and supplies.
All these issues of the “recomplete” plus a report of the U.S. Department of Health and Human Services that outlines Round 1 savings should trigger the HME industry to continue educating lawmakers on problems with competitive bidding and pushing for the market pricing program, say stakeholders.
Providers Push to get the Bid Window Re-opened
HME Providers who claim Agape Medical failed to submit their bids on time for Round 2 competitive bidding are sharing their experiences and concerns with the CBIC and CMS, lawmakers, state attorney general, and local newspaper in an effort to get the bid window re-opened.
Many providers participated in a conference call. They have levied charges that range from lack of communication to breach of contract against Agape Medical. For now, these providers are not filing a lawsuit because it is expensive and it wouldn’t give them their bids back.
On the other hand, Kaplan, Kenegos & Kadin, the law firm representing Agape Medical, stated that they have not found a case where their client has done anything incorrect in terms of processing bids. However, Mark Higley of the VGM Group believes that Agape did not follow the some basic rules of the program which hurts a provider’s chance of being awarded a contract even if the bid did get in on time.
Sleep Apnea Recommendations as Rule Guidance for FMCSA
According to a spokesperson from the Federal Motor Carrier Safety Administration (FMCSA), as first of a two-part process for a subsequent apnea rulemaking, the agency wants to adopt sleep apnea recommendations made by its two medical advisory bodies. The second step is a final review process before the rulemaking.
The recommendations include a body mass index or BMI of 35 or higher and Apnea Hypopnea Index or AHI of 20 or more as triggers for testing and treatment, which is through the use of a Positive Airway Pressure or PAP. In a notice, FMCSA states that it “proposes to adopt the recommendations as regulatory guidance after reviewing and evaluating comments receive from the public.”
In the recommendations, drivers having a BMI of 35 or higher could be conditionally certified for 60 days pending sleep study and treatment, followed by a 90-day certification if found compliant during the first 60 days, followed by a one-year certification. In addition, drivers would be immediately be denied certification if they admit to excessive daytime sleepiness while driving or have experienced a crash associated with falling asleep or have been non-compliant with PAP treatment.
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