Help Urged for Emergency Services through CMS

In a recent letter, 123 bipartisan members of Congress urged leaders for help in strongly encouraging the Centers for Medicare and Medicaid Services (CMS) to revise policies governing Medicare’s payment of emergency services, supplies, and other obligations after 36 months of service.

Reps. Mike Ross (D-AR), Tom Price (R-GA), Heath Shuler (D-NC) and Jo Ann Emerson (R-MO), led the writing of the letter which addresses Centers for Medicare and Medicaid (CMS) policies that require home oxygen providers to provide, without any payment, unscheduled service and maintenance visits, 24-hour emergency care, equipment repairs and oxygen supplies for two years following the 36-month rental cap. The CMS policies also require the original oxygen provider to ensure the provision of these services even when a beneficiary moves to a part of the country where the provider does not operate.

Citing lack of payments and “unreasonable obligations,” the letter states that CMS policies “are impeding the provision of quality care to Medicare beneficiaries on home oxygen therapy…” If you were looking at any other business, we would not be insisting that they operate this way. That’s like having a plumber in Minnesota who put in a water heater bear reaponsibility for the family’s new water heater in their new home in Nebraska.

Praising the letter, Chairman of the Council for Quality Respiratory Care (CQRC) Peter Kelly said “We applaud these members of Congress for standing up for home oxygen patients and providers in their communities.” CQRC is a coalition of leading home oxygen therapy providers and manufacturers who care for nearly one half of the 1.5 million Medicare home oxygen beneficiaries. “We, too, have urged CMS to use its authority to make payments for services and supplies required by beneficiaries after 36 months.”

On January 1, 2009, massive cuts to the Medicare home oxygen benefit, in the form of a 36-month cap enacted by Congress in the Deficit Reduction Act of 2005 (DRA), took effect, sending a slow but growing tidal wave of change throughout the provider community. In addressing the implementation of the 36-month cap policy, CMS issued a regulation that home oxygen providers will no longer receive Medicare payment for patient-generated, non-routine emergency visits or needed oxygen supplies, such as oxygen tubing and masks, once a beneficiary reaches the three year mark. These CMS-developed policies came at a time when the home oxygen benefit was also subject to a payment cap and an additional 9.5 percent across the board cut. The collective impact of these policies equals a 27 percent cut, totaling $845 million this year alone.

Excerpts from the letter to Speaker Pelosi, Majority Democratic Leader Hoyer and House Republican Leader Boehner, urging House leaders to ask CMS to revise post 36-month payment for home oxygen include:
“CMS’ final rule, published on October 30, 2008, addressing the treatment of oxygen therapy post 36 months established very limited payment levels and unreasonable obligations that are impeding the provision of quality care to Medicare beneficiaries on home oxygen therapy. We seek your assistance in urging CMS to revise post-36 month oxygen payment policies to address serious shortcomings that are creating hardships for both oxygen patients and providers of these services. Without immediate changes to the Medicare policies patient care will be compromised and Medicare costs will increase.”

The Council for Quality Respiratory Care, a coalition of the nation’s leading home oxygen therapy providers and manufacturers representing nearly one half of the more than 1.5 million Medicare beneficiaries who depend on the home oxygen benefit for independence and quality of life.