Ohio Department of Medicaid “Final Files” HME Rules; Policies Effective 7/01/21

OAMES received notice this week from the Joint Committee on Agency Rule Review (JCARR) that the Ohio Department of Medicaid has “final filed” the HME rules which go into effect on 7/01/21.  To access the rules, click on the respective links below.  (In the “Type” column, click on the rule line designated “New”, not “Rescission”, for the final draft.)

• 5160-10-01 – General provisions
• 5160-10-06 – Wearable cardioverter-defibrillators
• 5150-10-07 – Bathing seats
• 5160-10-10 – Home dialysis equipment and supplies
• 5160-10-13 – Oxygen
• 5160-10-16 – Wheelchairs
• 5160-10-19 – Positive airway pressure devices
• 5160-10-22 – Ventilators
• 5160-10-29 – Insulin pumps

To access the DMEPOS Appendix to OAC rule 5160-10-01 with the payment schedule effective 7/01/21, click here.  If the link doesn’t work, you can access the 35-page PDF file here:

http://www.registerofohio.state.oh.us/pdfs/5160/0/10/5160-10-01_PH_FF_N_APP1_20210621_0829.pdf

OAMES is continuing to discuss and analyze data on the MSRP vs Cost Plus issue with ODM.  We are hoping to wrap-up those discussions soon and anticipate that the Department will publish a guidance document when finalized. We are still waiting to hear back on the final versions of the Certificates of Medical Necessity forms and will pass along news as soon as we hear from ODM.  If you have any questions on the Medicaid rules, please feel free to contact OAMES executive director Kam Yuricich.    

Regional and National Efforts on Philips Recall; AASM Second Webinar Tomorrow

OAMES is aware of multiple efforts underway to share information and connect those affected by the recent voluntary recall for Philips respiratory devices.  According to the recall notice, HME providers, distributors and medical institutions who supply these products should have received a letter by June 23 with log-in credentials to register.  If you did not receive this letter, please call Philips at 1-877-907-7508.

The Medicare Councils for A, B & C have been meeting to discuss the issue and gather questions from providers across the country to share with DME MACs and CMS regarding Medicare beneficiaries who are impacted.  We are expecting additional information early next week so watch for an update.

OAMES also just received notice today from our Medicare Council office that letters regarding the Philips recall were sent to CMS and various payers related to HME policies from the American Academy of Sleep Medicine (AASM), American Academy of Neurology (AAN), American College of Chest Physicians (CHEST), American Thoracic Society (ATS), Alliance of Sleep Apnea Partners (ASAP), and the American Sleep Apnea Association (ASAA).  You’ll find the CMS letter here and payer letter here.

Additionally, the American Academy of Sleep Medicine is hosting their second live panel discussion related to the recent PAP device recall notification tomorrow, June 25, at 3-4 pm Eastern.  This session will focus on impacts on vulnerable populations, including pediatric patients, the hospitalized, patients who are dependent on a ventilator, and research participants. The Zoom-enabled event will also include a discussion on the allocation of limited supplies and how to prioritize the medically most needy given the limited supply of home ventilators for patients needing them.

See more information and join the webinar here.

No advance registration is required. Attendee interest exceeded webinar capacity last week, so you may wish to log in earlier than the start time. A recording will be posted online following the live event.  OAMES and AAHomecare are not sponsors or participants in the webinars but we’ve had good feedback that the first one was helpful. Details and the recording from last week's webinar can be found here.

CMS Announces 90-Day Extension for CRT Manual Wheelchair Accessories

Yesterday, CMS announced a 90-day extension of the suspension of the application of Medicare Competitive Bidding program pricing to complex rehab technology (CRT) manual wheelchair accessories. The current policy will stay in place through October 1 and there will not be any payment cuts or claims processing changes.  The full announcement from CMS can be found here.  While this is not a permanent fix, it shows that the concerns of the CRT community are being heard and listened to. Thank you to NCART and AAHomecare for their leadership and efforts on this extension and the Congressional leaders and CRT advocates who took action to protect access to CRT manual wheelchairs.  See the letter and complete list of Congressional signers for more details.