In brief: Bid language moves, AdaptHealth gets sued, NC DME wins

WASHINGTON – Language that would extend the 75/25 blended Medicare reimbursement rate in non-bid areas through 2024 is included in a draft of omnibus health care legislation in advance of a Senate Finance Committee mark-up session that could take place as early as this week. 

Inclusion in this initial draft of legislative language to be considered by the committee does not guarantee the 75/25 provisions from S. 1294 will, ultimately, pass into law, but it's a significant step forward in the legislative process, says AAHomecare in a bulletin. 

HME advocates in states with Senate Finance Committee members are urged to send an email to health care committee staffers this week with this message (in your own words, if possible): 

“Please support language from S. 1294 to extend the 75/25 blended Medicare reimbursement rate for DME through 2024 in upcoming Senate Finance Committee consideration of healthcare legislation (section 405 of related legislative discussion draft). This measure will help DME suppliers continue to provide cost-effective, patient-preferred home-based care and send a message to CMS that a longer-term, market-based solution is needed.” 

These states are represented by a senator on the Finance Committee:  Colorado, Delaware, Idaho, Indiana, Iowa, Louisiana, Maryland, Massachusetts, Montana, New Hampshire, Nevada, New Jersey, North Carolina, Ohio, Oklahoma, Oregon, Pennsylvania, Rhode Island, South Carolina, Tennessee, Texas, Virginia, Washington, Wisconsin, Wyoming. 

AAHomecare recommends calling the senator’s office and asking for the name and email of the individual who handles health care issues; most offices will readily share that information. 

Pre-drafted emails to Senate Finance Committee members can also be sent using AAHomecare’s Voter Voice system: See the message here.  

The related language can be found in Section 405 of the discussion draft (page 117). 

Class action filed against AdaptHealth  

PLYMOUTH MEETING, Pa. – A class action lawsuit has been filed against AdaptHealth alleging the company misrepresented the strength of its diabetes business, causing investors to pay inflated prices for shares in the company. 

The lawsuit, filed Oct. 24 in the United States District Court for the Eastern District of Pennsylvania by the Allegheny County Employees Retirement System, alleges that between Aug. 4, 2020, and Feb. 27, 2023, AdaptHealth and certain senior executives overcharged CMS and other insurance providers by submitting improper billing codes for diabetes equipment and that the company and certain senior executives made numerous false and misleading statements to investors during the period. 

In 2021, for example, materials and documents associated with a secondary public offering of shares allegedly contained untrue statements of material fact and omitted to state material facts that were required by applicable law and necessary to make the statements therein not misleading. As a result, AdaptHealth common stock traded at artificially inflated prices during the period, according to the lawsuit. 

AdaptHealth’s alleged misconduct came to light Feb. 27, 2023, when the company announced a surprise loss of $0.02 per share for the fourth quarter of 2022, which was significantly lower than the gain of $0.27 per share that analysts and investors were led to expect. The company also reduced its guidance for 2023, lowering revenue expectations by more than 1.5%. AdaptHealth attributed the miss and lowered guidance to “tempered expectations on diabetes.” As a result, the price of the company’s common stock declined precipitously. 

Named in the complaint are Luke McGee, Josh Parnes, Stephen Griggs, Jason Clemens, Frank Mullen, Richard Barasch and several other executives, along with several financial firms, including Deutsche Bank, Jefferies, BOFA Securities and Truist Securities. 

The lawsuit seeks compensatory damages and reasonable costs and expenses incurred in the action, including attorney fees and expert fees. 

CMS details lymphedema coverage, supply refills, brace definitions 

WASHINGTON – CMS has released a 2024 Home Health Prospective Payment System Rate Update final rule that includes updates to its new coverage policy for lymphedema compression garments and other DME-related items. 

Per the final rule, Medicare will pay for three daytime garments every six months and two nighttime garments every two years for each affected extremity or part of the body, an increase in daytime garments over the amount previously proposed. 

This rule also establishes the initial HCPCS codes and the payment methodology for these items and outlines how future coding, benefit category, and payment determinations for these items will be made. 

DMEPOS refills 

In response to concerns related to auto-shipments and delivery of DMEPOS supplies that may no longer be needed or not needed at the same level of frequency/volume, CMS will institute policies requiring suppliers to contact the beneficiary prior to dispensing DMEPOS refills. The agency will require documentation indicating that the beneficiary confirmed the need for the refill within the 30-day period prior to the end of the current supply. Additionally, CMS will codify its requirement that delivery of DMEPOS items (that is, date of service) be no sooner than 10 calendar days before the expected end of the current supply. 

Brace definition 

The rule also codifies the longstanding Medicare definition of brace to provide clarification on the scope of the Part B benefit for leg, arm, back and neck braces and, as a result, CMS will classify certain exoskeleton-type devices as braces for payment purposes. 

Read a fact sheet on the final rule. 

Providers in NC to receive rate increase 

RALEIGH, N.C. – HME providers in North Carolina will receive a rate increase for 13 products that equates to about $3.2 million more for their bottom lines over an eight-month period. 

Members of ACMESA’s Medicaid and legislative committees and AAHomecare’s payer relations team have lobbied for the increase for two years, following the state’s decision to discontinue a 5% rate increase related to the COVID-19 pandemic. 

“ACMESA is thankful for the rate increase provided on essential codes on the DME fee schedule,” said Beth Bowen, executive director of ACMESA.  “Our strong relationship with N.C. Medicaid is one we value and has enabled our providers to continue to provide quality DME services to North Carolina Medicaid beneficiaries. ACMESA and AAHomecare will continue to fight in the next legislature to obtain a much needed across the board increase. Now is the time to continue to reach out to our legislators to remind them of the value DME brings to NC Medicaid.”  
 
The rate increases go into effect on Nov. 1.  Stakeholders expect additional details from N.C. Medicaid soon. 

Tomorrow Health shows results 
NEW YORK – Tomorrow Health recently released new data with Geisinger Health Plan that shows an 83% reduction in care and supply delivery times since March 2021. The company is using the data to illustrate how improving home-based care delivery can have measurable impacts on health plan costs, member satisfaction and overall health outcomes for patients. "We are grateful to work with Geisinger to improve the home-based care experience for over 600,000 members in Pennsylvania," said Vijay Kedar, founder and CEO of Tomorrow Health. "Together we've leveraged technology to improve the home-based care process for Geisinger's expansive network of providers and suppliers, and delivered meaningful care outcomes for patients and families. It's an honor to work with a pioneering organization like Geisinger to shape the future of care at home." Geisinger Health Plan manages the care of more than 600,000 members across Pennsylvania, both in facilities and at home. Other results the plan has seen since partnering with Tomorrow Health: 

A 4x return on investment (ROI); 

95% GHP member satisfaction rate; 

87% end-to-end visibility of orders placed by providers through Tomorrow Health's online portal; 

93% of suppliers in Geisinger's network now have a 4 or 5 (out of 5) customer satisfaction rating; and 

100% of suppliers saw improved performance with Tomorrow Health. 

BOC recognized for outstanding customer service 

OWINGS MILLS, Md. –The Board of Certification/Accreditation (BOC) has received a Gold TITAN Business Award for its continued commitment to providing outstanding customer service. The International Awards Associate (IAA) received more than 1,300 nominated entries in 58 countries across the globe for the TITAN award, which recognizes excellence in the business industry. BOC earned a Gold Award for implementing Net Promoter Score (NPS), which is a nationally recognized barometer ranging from -100 to +100 used for measuring customer loyalty and satisfaction. “At BOC, we believe every aspect of a customer’s experience should be meaningful, efficient and seamless,” says Judi Knott, BOC president & CEO. “That’s why we hold ourselves accountable to rigorous standards of quality and service. We are proud to be the only DMEPOS accrediting organization utilizing the NPS model and prioritizing the measurement of our customer satisfaction as an important component of our success. We are ecstatic to uphold and further validate our reputation as an organization committed to customer service.” The IAA welcome submissions from entrepreneurs, SMEs and organizations of varied sizes, but only those who meet the highest criteria earn TITA awards. 

USITC rules Apple unlawfully used Masimo technology 

WASHINGTON – The United States International Trade Commission has found that Apple violated U.S. laws by incorporating Masimo’s patented light-based pulse oximetry technology in its products and has recommended a limited exclusion order. “Today’s ruling by the USITC sends a powerful message that even the world’s largest company is not above the law,” said Joe Kiani, founder, chairman and CEO of Masimo. “This important determination is a strong validation of our efforts to hold Apple accountable for unlawfully misappropriating our patented technology.” Comments from two dozen academic institutions, leading antitrust and intellectual property scholars, physicians, investors, nonprofits and members of Congress were filed in support of the public’s interest in the exclusion order. These comments conveyed a similar message: to protect innovation, such as Masimo’s technology, and to protect public health, it is necessary to preserve incentives to innovate and protect intellectual property and fair competition.