In brief: Breast forms legislation, NIV win, Medline truck rodeo

WASHINGTON — Reps. Judy Chu, D-Calif., and Mariannette Miller-Meeks, R-Iowa, have reintroduced the bipartisan Breast Cancer Patient Equity Act, which would provide Medicare coverage of custom breast prostheses to breast cancer survivors. 

The bill, H.R. 4779, would allow hundreds of thousands of women each year to choose a custom prosthesis after a mastectomy. 

“This is a great step forward in our efforts to expand access to life-changing health care for breast cancer survivors,” said Nikki Jensen, vice president of Essentially Women, a division of VGM. “We ask that anyone affected by breast cancer, or anyone who just feels that this is the right thing to do, to please contact their elected officials and show support for the Breast Cancer Patient Equity Act.”  

While Medicare covers many other post-mastectomy treatment options and other custom prosthetic devices, custom breast prostheses are not covered by Medicare because they’re considered medically unnecessary. 

“During such fragile times when women are dealing with the stress and toll of invasive breast cancer, line items of their insurance coverage are the furthest things from their minds,” said Rep. Miller-Meeks. “The Breast Cancer Patient Equity Act takes away the burden of calculating the coverage for custom prosthetics and gives access to higher quality implants for patients diagnosed with invasive breast cancer that undergo a mastectomy, regardless of their income.” 

For more information and to take action, visit www.peopleforqualitycare.org/letherdecide.  

NCART hires new membership coordinator 

WASHINGTON – NCART has hired Tim Hoffman as its new membership coordinator. Hoffman has 26 years of experience in the industry, most recently as vice president of vendor contracting and strategic accounts for VGM & Associates. “NCART is excited to be working with a well-established industry veteran like Tim,” said Wayne Grau, executive director. “Tim has longstanding relationships with CRT manufacturers and suppliers. This addition will allow NCART to continue to expand our advocacy reach for the complex rehab industry.” For more information on joining NCART, Tim can be contacted at 319-230-5004 or thoffman@ncart.us. 

Mississippi providers score win on NIV guidance 

JACKSON, Miss. – BlueCross BlueShield of Mississippi has updated its policy guidance to un-cap non-invasive ventilator rentals and update oxygen rentals in accordance with CMS guidelines. The new guidelines go into effect Aug. 1, 2023, according to a bulletin from AAHomecare. The Mississippi Association of Medical Equipment Suppliers (MSAMES) has engaged in persistent advocacy with policymakers and payers in the state to strengthen access to this critically important equipment, AAHomecare says. In 2022, MSAMES and AAHomecare successfully advocated for HB657, which included provisions prohibiting the state’s Medicaid program and MCOs from capping NIV payments. In 2023, they advocated for SB2224, which prevents payers from capping rental months for NIV and ensures health equity for medically complex individuals who meet medical necessity for this life saving equipment. 
  
Medline holds National Truck Rodeo 

GRAYSLAKE, Ill. – Medline recently hosted is first ever National Truck Rodeo to honor its more than 1,500 drivers of tractor trailers, straight trucks and parcel vans who the company says were vital during the COVID-19 pandemic. Ten drivers from California, Florida, Georgia, Illinois and New York – regional finalists from previously held tests of skill and safety – participated in the event, held at a distribution center near the company’s headquarters.  “Our drivers know the important role we play in health services delivery,” says Jeff Brennan, senior vice president of transportation at MedTrans, the transport fleet of Medline. “We give that extra effort because we recognize that it could be our own family, or friends or community members waiting for the right medical supplies to get through a surgery, or a hospital stay or just to help them feel better.” Examples of the tests included backing straight up over 50 feet, driving forward and backward around cones without touching any, and backing up to a loading dock. The Rodeo had six winners in two categories. Package and straight trucks: 1st place, Luis Becerra Leal of Katy, Texas; 2nd place, Samuel Garcia of Modesto, Calif.; and 3rd place, Ivan Arroyo, of Chicago. Tractor trailers: 1st place, Arthur “AP” Porn, Hemet, Calif; 2nd place, Troy White, McDonough, Ga.; and 3rd place, Brad Willard, Wadsworth, Ill. First-place winners received $2,500, second place winners received $1,000 and third place winners received $500. 

Superior Van acquires Gulf States Mobility 

DALLAS – Superior Van and Mobility has acquired Gulf States Mobility, according to Generational Equity, adviser to GSM. The Wetumpka, Ala.-based GSM is a provider of sales, service and repair of wheelchair accessible vehicles. The company also offers wheelchair and scooter repair, as well as commercial transit bus wheelchair lift, electrical system and air conditioning repair and services. SVM, headquartered in Louisville, Ky., is a family-owned mobility dealer with 17 locations throughout Indiana, Kentucky, Tennessee, Louisiana, Arkansas, Alabama, Nebraska, Michigan and Florida. Its primary business is providing customers with an extensive selection of new and used wheelchair vans, wheelchair-accessible SUVs, wheelchair and scooter lifts, and adaptive equipment. The company is a member of the National Mobility Equipment Dealers Association (NMEDA) and a participant in NMEDA’s Quality Assurance Program (QAP), a recognition reserved only for the highest quality mobility dealers in the country. The deal closed June 30. 

Man charged in telemedicine scheme 

BOSTON – David Santana, owner of Conclave Media and Nationwide Health Advocates, will plead guilty to one count of conspiracy to commit health care fraud in connection with a $44 million telemedicine fraud scheme involving medically unnecessary durable medical equipment, including orthotics such as back and knee braces, and genetic tests. According to the charging documents, between January 2018 and August 2021, Santana, through his companies Conclave and Nationwide, entered into business relationships with telemarketing companies that generated leads by targeting Medicare beneficiaries. The telemarketers then allegedly paid Conclave and Nationwide on a per-order basis to generate orders for DME and genetic testing for these beneficiaries. To arrange for these orders to be signed, Santana allegedly worked with medical staffing companies to find doctors and nurses who were willing to review and sign prepopulated orders, typically without any contact with the beneficiaries. It is alleged that the records falsely portrayed the medical providers as having performed a legitimate examination of the beneficiary. Santana then allegedly provided the signed orders to the telemarketing companies, which then sold the orders to DME suppliers and laboratories. It is alleged that Santana knew these DME suppliers and laboratories would use the signed orders to submit claims to Medicare for DME and genetic testing that were medically unnecessary, based on false documentation and tainted by kickbacks. The charge of conspiracy to commit health care fraud provides for a sentence of up to 10 years in prison, supervised release for up to three years, and a fine of up to $250,000 or twice the gross pecuniary gain or loss, whichever is greater.  

Thune, Warner introduce pharmacy access bill 

WASHINGTON – Sens. John Thune, R.-S.D., and Mark Warner, D-Va., have introduced the Equitable Community Access to Pharmacist Services Act, bipartisan legislation that would ensure seniors can continue to access certain clinical services from their pharmacist. The bill would allow Medicare to reimburse for certain pharmacist-administered tests, treatments and vaccinations for influenza, respiratory syncytial virus (RSV), COVID-19 and strep throat, in accordance with state scope-of-practice laws. “Seniors across South Dakota rely on the care and support they receive from their community pharmacist,” said Thune. “I am proud to lead this common-sense legislation that would allow these trusted sources for vaccinations and other important treatments to remain a reliable option for seniors.” Added Warner: “Pharmacists play a key role in delivering health care services in our communities,” he said. “This legislation will make care for common illnesses – including flu, COVID, RSV, and strep throat – easier for seniors to access by allowing pharmacists to seek reimbursement from Medicare for services that they are already licensed to perform under state laws, such as testing and vaccination.”