In brief: NHIA sues over transitional payment, Great Elm’s DME biz exceeds expectations

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Friday, February 15, 2019

WASHINGTON – The National Home Infusion Association is suing the Department of Health and Human Services over its transitional payment for home infusion therapy services.

A final rule published in November 2018 limits reimbursement for professional services to only those days a “skilled professional is in the home.”

Under CMS’s interpretation, reimbursement for services by pharmacists and other professionals services are not recognized, according to a press release.

“This rule undercuts Congress’ intent to ensure that Medicare beneficiaries can access these therapies in the safety and comfort of their own homes,” said Varner Richards, PharmD, chairman of the NHIA board of directors and a home infusion pharmacist in Columbia, S.C. “It simply doesn’t reflect the reality of how home infusion services are currently delivered and reimbursed.”

The rule implemented the transition payments on Jan. 1, 2019, through Dec. 31, 2020 to address a payment gap created by the 21st Century Cures Act.

NHIA and other home infusion stakeholders have sought to modify the regulations, which they say do not align with Congressional intent.

“We believe the agency violated the statute and have concluded that legal action is our only recourse for protecting the interests of our members and access to services by Medicare beneficiaries,’ said Connie Sullivan, NHIA president and CEO.

Great Elm’s DME biz exceeds expectations

WALTHAM, Mass. – Great Elm Capital Group, which acquired and merged Valley Healthcare Group and Northwest Medical last year, reported that DME generated $13.2 million of revenue, $400,000 of net income and $3.6 million of adjusted EBITDA in the second quarter of 2019, exceeding original expectations. “In addition to driving organic revenue and EBITDA growth, the DME operating team is aggressively working to realize additional, potential synergies by the end of calendar year 2019,” the company stated. “The team is also pursuing potential M&A opportunities with complementary product profiles that increase market penetration and extend existing geographic markets.” Great Elm says it has two DME companies currently under letters of intent (LOIs) and continues to conduct diligence on companies across multiple industries. Great Elm also reported that new CPAP/BiPAP patient setups increased more than 25% in the second quarter compared to the same quarter last year.

KCI to close NC service center

SAN ANTONIO – KCI USA has alerted state officials that it plans to eliminate 65 jobs at a service center in Charlotte, N.C., according to a local TV station. KCI, an Acelity Company, decided to “substantially reduce” its workforce after analyzing its “business situation and its available options,” according to a Worker Adjustment and Retraining Notification Letter filed with the North Carolina Department of Commerce. KCI will lay off employees in four phases, starting July 5 and ending Sept. 27, and then close the center, the TV station reports. The bulk of the jobs impacted are in order fulfillment support and management, with additional jobs impacted in billing and collections, customer service and administrative support. More than 30 employees from the center will continue to work remotely from home. KCI says it employs 5,000 people around the world.

Lymphedema bill reintroduced

WASHINGTON – Sens. Maria Cantwell, D-Wash., and Todd Young, R-Ind., reintroduced The Lymphedema Treatment Act on Feb. 14. The bill, S. 518, would require Medicare to pay for compression garments, bandages and supplies to reduce lymphedema-related swelling and prevent recurrence. It has 32 original co-sponsors. A previous version of the bill was introduced in both the House of Representatives and the Senate in 2017. Those bills, ultimately, garnered 385 and 66 co-sponsors, respectively.

PHS adds Dr. Schmerling to board

ST. PAUL, Minn. – Pediatric Home Service, an independent pediatric homecare company, has appointed a new board member: Dr. James Schmerling, DHA, FACHE, president and CEO of Connecticut Children’s Medical Center. “WE are confident in his expertise in children’s health will be of great value to our team as we continue to identify opportunities that will allow us to further serve children with medical complexities and their families,” said Mark Hamman, CEO of PHS. Dr. Schmerling is a fellow in the American College of Health Care Executives and an adjunct faculty member in the Hospital Administration programs at the University of Alabama at Birmingham. He also serves on the board of Biostage, an OTC traded bioscience company based in Boston, the Regional Policy Board of the American Hospital Association, and the Board of Governors of the Children’s Miracle Network.

Billing reminders: RTLT modifiers, DWOs, ABNs

WATERLOO, Iowa – HCPCS codes that require the RTLT modifiers need to be on two separate claim lines effective for dates of service beginning March 1, VGM has alerted providers. Currently, it’s acceptable to use one claim line with two units of service with RTLT…VGM has also reminded providers that they can complete detailed written orders for CPAP accessories, with the exception of the physician’s signature and signature date. VGM says that DWOs are not required prior to delivery but are required prior to submitting claims for reimbursement. “Best practice is to obtain all the necessary information prior to delivery to make for a smoother transaction,” it says…Do providers need ABNs for non-assigned claims? The short answer is no, VGM has advised providers. The reason for denial on the ABN can’t state, “Claim is non-assigned because the reimbursement is lower than my cost.” ABNs are issued when there is reason for denial, such as lack of medical necessity, same/similar equipment, upgrades and overutilization, VGM has reminded providers.

KMESA calls for support of MCO-related bill

FRANKFORT, Ky. – KMESA is asking HME providers in Kentucky to support HB 224. Introduced last week by State Rep. Kim Moser, the bill seeks to ensure that DME providers are paid at the rate set by Kentucky Medicaid. It would also require that, should a patient transfer from one Medicaid managed care organization to another, services that are currently being provided under a PA will be honored by the new MCO; and require MCOs to cover, at a minimum, the same quantities of supplies covered under the Medicaid fee schedule. “This is a short session and the clock is not our friend,” KMESA stated in an alert. “The calls need to come in volume and soon. The administration has concerns about the costs of increased reimbursements and the MCOs are going to put up a tough fight.” Providers are urged to contact the state house switchboard at 502-564-8100 and ask to be connected to the appropriate office.
 


FODAC joins volunteer coalition

TUCKER, Ga. – Friends of Disabled Adults and Children has been accepted into National Voluntary Organizations Active in Disaster (National VOAD), a coalition of volunteer organizations dedicated to helping survivors and their communities in the wake of disasters. FODAC, which provides DME and services to those living with disability, has established itself as a leader in disaster recovery efforts for special needs survivors since Hurricane Maria in 2018. “We are honored to join this well-respected organization dedicated to facilitating a more coordinated, cooperative response throughout the disaster cycle,” said Chris Brand, president and CEO of FODAC. “Over the past 15 years, since our first big disaster recovery initiative with Hurricane Katrina, we have developed relationships with FEMA and many of the National VOAD member organizations. Now we look forward to more structured relationships and adding our expertise to address current and on-going needs for seniors and others with disabilities in the aftermath of large population-affecting emergency events.”

Law firm launches investigation, seeks info on Inogen

SAN DIEGO – Johnson Fistel, LLP, along with the California Deputy Attorney General, is investigating potential claims against Inogen for violations of state and federal securities laws in connection with statements the company made to the investing public. The Johnson Fistel investigation is based on research published Feb. 8 by Carson Block of Muddy Waters Research and an additional report published on Feb. 12 by Andrew Left of Citron Research. Block estimates that Inogen’s total addressable market for POCs to be 1.3 million, not 3 million as the company has claimed.

Busy week for HOMES

BOSTON – Competitive bidding, reimbursement and audits were among the topics discussed at a Feb. 12 meeting between HOMES and HHS and CMS officials. The 90-minute meeting was the result of an invitation of HHS Secretary Alex Azar. "We covered a wide array of issues and will be following up with additional information,” said Karyn Estrella, HOMES executive director, in a bulletin. Also in attendance was David Reilly, clinical coordinator at Sturdy Memorial Hospital in Attleboro, Mass., who discussed delayed discharges and increased hospital readmissions. Providers from across New England attended the meeting, including Gary Sheehan, CEO of Cape Medical Supply, in Sandwich, Mass. "HHS and CMS officials clearly recognize ongoing issues with the competitive bidding program and appear to be regularly fielding issues and performing triage to ensure patients receive care,” he said. “They recognize that the suspension of the bid program is a change, what they failed to appreciate was the lack of relief on reimbursement does little to level the playing field.” HOMES also met with New Hampshire State Sen. Tom Sherman, chairman of the HHS committee that oversees the Medicaid program, to discuss the state’s next round of Medicaid managed care contracts. Providers have had ongoing issues with the current managed care plans, according to the bulletin. Sen. Sherman indicated he was open to drafting legislation and possibly calling a hearing on the matter.

PE firm invests in Montgomery DME

LOS ANGELES – Monument MicroCap Partners has recapitalized Montgomery DME (MDME), a provider of DME to hospices in Los Angeles and surrounding counties, according to PEHub.com. Monument and MDME also closed the acquisition of Abundant Home Care to create a regional provider of DME to hospices throughout southern California. “We are excited to partner with Monument and AHC on the next chapter of our growth strategy,” said Pablo Miguel, vice president of MDME. “Monument will provide us with strategic support and capital as we continue with our steadfast commitment to providing the highest quality of compassionate service to our clients and their patients.” Monument MicroCap is an Indianapolis-based private equity firm. 

CVS debuts expanded healthcare concept stores

HOUSTON – CVS is debuting three HealthHUB locations in Houston as it seeks to shift more floor space from retail goods to healthcare services, according to an article in USA Today. The HealthHUB locations will include additional space for CVS MinuteClinic nurse practitioners, now capable of additional services like phlebotomy, diabetic screening and sleep apnea assessment. The move comes in the wake of a $69 billion merger between CVS and Aetna. "By bringing those services to help them better manage their chronic diseases, we can really increase their awareness, their engagement, the experience with those services and ultimately help them manage their own diseases and be healthier, which in turn lowers overall health care costs," Alan Lotvin, CVS chief transformation officer, said in an interview.

ACHC renews partnership

CARY, N.C. – The Accreditation Commission for Health Care has renewed its partnership with Rhode Island Partnership for Home Care. Per the agreement, Rhode Island Partnership’s members can receive special pricing on ACHC’s home health, hospice, and private duty accreditation services, as well as discounts on ACHCU educational resources. “ACHC looks forward to continuing our partnership with Rhode Island Partnership for Home Care to offer their members resources and education that will empower them to provide the highest quality patient care,” said Matt Hughes, ACHC director of business development.