In brief: Philips recall, Senate honor, NPWT bill

WASHINGTON – VGM has asked the U.S. Food and Drug Administration to expedite its approval process for a replacement foam for respiratory devices affected by the Philips recall. 

“We are requesting accelerated approval from the FDA for this critical replacement component for approved technicians to rapidly start the process of replacing/repairing all recalled units,” states VGM in a letter to the agency. 

Philips on June 14 announced a voluntary recall of certain Bi-Level CPAP, CPAP and mechanical ventilator devices to address identified potential health risks related to the polyester-based polyurethane sound abatement foam component in these devices. 

VGM points out in the letter that the recall has exacerbated an existing product shortage related to ongoing supply chain issues. 

“Currently there is a shortage of manufacturers of these devices with inventory constraints to adequately increase production to absorb the demand for these devices typically provided by Philips Respironics,” it states. “Swift action is needed to protect access to these products and avoid a device shortage that would further burden an already stressed healthcare system.” 

State news: Massachusetts, Pennsylvania 

BOSTON – The MassHealth Medicaid program is implementing a 10% rate increase for DME claims with dates of service effective July 1, 2021.   

It's also implementing a 50% increase for labor code K0739, which covers repair or nonroutine service for DME other than oxygen equipment requiring a skilled technician. 
“This is a big win when we needed it most,” said Jason Morin, president & CEO of HOMES. “Between the pandemic impacts and the recent respiratory recall, providers are reeling and struggling to find ways to continue to absorb these rising costs. This action provides much-needed direct relief to the providers of Massachusetts and also shows us that the state’s Medicaid leadership is listening.” 

MCO legislation introduced in Pennsylvania 

Republican state Rep. Tommy Sankey has introduced a bill in the Pennsylvania House of Representatives that seeks to prevent self-referrals by managed care organizations. 

The legislation, HB 1726, would amend the state’s Human Services Code as follows: 
“Section 1419. Managed Care Plan Prohibition – Notwithstanding any other provision of law, a managed care plan [MCO definition language] may not refer or enter into a subcontract arrangement to provide services defined and specified in the managed care plan contracts with an entity where the entity or managed care plan may self-refer for durable medical equipment and supply services.” 
AAHomecare has worked with PAMS to build support for the legislation. 

AAHomecare encourages HME suppliers and other stakeholders in Pennsylvania to reach out to their state representatives in support of the measure through this Action Center. 

California moves to protect complex rehab 

EAST AMHERST, N.Y. – The California State Legislature on July 15 passed Assembly Bill 133, which includes language to improve and protect access to complex rehab technology for people with disabilities, according to NCART. 

The bill will permanently exempt CRT from a long-standing Medi-Cal provider cut of 10% and will strengthen policies regarding the evaluation and delivery of complex rehab. 

“We are extremely thankful to the California Legislature for passing this important CRT provision,” said Don Clayback, executive director of NCART. “Their action will help children and adults with disabilities receive the individually configured CRT and supporting services they depend on.” 

California is the eighth state to pass complex rehab-focused legislation, according to NCART. 

Among the supporters of the bill, which now goes to Gov. Gavin Newsom for signing, were Sen. Bill Dodd, the California Association of Medical Product Suppliers, California Children’s Hospital Association, Children’s Specialty Care Coalition, Disability Rights California, Advanced Medical Technology Association, Spinal Care Network, National Multiple Sclerosis Society, Care to You Health and AdvaMed.  

CGS updates FAQ on Philips recall 

YARMOUTH, Maine – CGS has updated its FAQ on the Philips recall, adding two new questions and revising three questions. 

The two new questions are: 

If a beneficiary with a patient-owned recalled device refuses warranty support or chooses to purchase a replacement device out of pocket, will the DME MACs honor an executed ABN that holds the beneficiary responsible for replacement (outside of warranty) as same or similar to equipment previously purchased be Medicare? 

The DME MACs will honor a properly executed ABN. The voluntary recall does not modify any of the CMS Reasonable Useful Lifetime regulations. 

Will we be able to bill Medicare using K0462 if we supply a customer with an alternate unit to use while they are waiting for Philips to repair/replace the unit that is patient owned and it could take several months to get a repair/replacement? Can the DME MACs allow K0462 to be billed for more than one month given the expectation that the repairs will take several months based on volume? 

Billing a rental unit under K0462 is allowed; however, suppliers should make every effort to minimize the time that a rental unit is utilized while awaiting repair. This may include working with the treating practitioner to substitute a different brand/model not impacted by the voluntary recall. For billing K0462, suppliers should enter “Philips recall” with the brand/model number impacted and date purchased. 

CGS clarified question 5 that applies to devices still under capped rental, clarified question 9 and added information to question 10 from the U.S. Food and Drug Administration. 

CGS originally posted the FAQ on July 16. 

Option Care partners with AlayaCare on software solutions 

BANNOCKBURN, Ill., and MONTREAL – Option Care Health and AlayaCare have established a technology collaboration to develop software for alternate site infusion therapy.  

This effort builds on an existing relationship, under which Option Care Health, a provider of home and alternate site infusion services, uses AlayaCare’s existing home and community care software to manage its clinical resources at the point of care.  

“The patient experience is at the forefront of everything we do, and we are confident that with our collaboration with AlayaCare we will better engage patients and their families through a differentiated care experience,” said John Rademacher, CEO of Option Care Health. “Our focus is to provide superior clinical outcomes through our extraordinary clinical team and these tools will create the technology enablement to help achieve this goal.”    

The collaboration will develop additional tools and capabilities to optimize the care delivery experience through advanced automation, patient communication and scheduling tools, improved assessment and data capture and an overall more efficient administrative process. 

The new tools, specifically, will help enhance patient engagement and develop a more comprehensive view of the clinical interactions and support throughout the course of therapy. 

“The mission of the AlayaCare team is to empower providers to deliver better outcomes through transformative technology and we are excited to build upon our existing relationship with Option Care and their market-leading platform to continue development of our unique technology suite,” said Adrian Schauer, founder and CEO of AlayaCare. 

PHE extended through October 

WASHINGTON – Xavier Becerra, secretary for the Department of Health and Human Services, on Monday extended the public health emergency from July 20 for another 90 days. 

There are several HME-related provisions tied to the PHE, including: 

Medicare’s 75/25 blended reimbursement rates for non-rural, non-competitive bidding areas 

Waivers of the coverage criteria and face-to-face requirements for respiratory therapy 

Reimbursement for telehealth services for physical and occupational therapists 

HHS initially declared the PHE on Jan. 31, 2020. 

NCPA’s Hoey tapped to lead global council 

ALEXANDRIA, Va. – Doug Hoey has been elected as president of the World Pharmacy Council, an international group with a mission of building international recognition of community pharmacy and its role, policies and value. “Community pharmacies in many countries have been integral to the fight against COVID-19 pandemic,” said Hoey. “I am humbled to be elected by my international colleagues to promote the work pharmacists are doing around the world to improve quality of care, lower overall health care costs, and act as local economic powerhouses to communities throughout the world.” In addition to the U.S., the WPC represents community pharmacy organizations in the United Kingdom, Ireland, Spain, Portugal, Denmark, Australia and New Zealand. 

PAMES taps new president, announces fall conference 

SEATTLE – PAMES has named Laura Berry as its new president. Berry is the founder and CEO of Soundview Medical Supply, a Seattle-based company focused on selling disposable medical supplies to senior care facilities. She is a current member of AAHomecare and vice chair of the association’s Medical Supply Council. Berry takes over the role from Paul Sabin of NORCO. The association has also announcecd plans to hold its fall conference Sept. 23 - 24, at the Seattle Embassy Suites, Pioneer Square, in Seattle. For more information, go here. 

Conferences: Medtrade West 2022, MAMES 

The deadline to submit proposals to present at Medtrade West 2022 is July 30. Show organizers seek submissions on topics for business operations, managed care payers, legal, retail, executive leadership and planning, and sales and marketing by solo presenters, panel discussions and collaborative teams. Medtrade West is scheduled for April 4-6, 2022, at the Phoenix Convention Center. Submit your proposal here…Registration is now open for the MAMES fall conference. “MAMES 2021: Together Again – A Family Reunion” takes place Oct. 6-8 at Treasure Island Resort & Casino in Welch, Minn. The early bird registration fee for providers is $89 and is all inclusive. For more information or to register, go here. 

Virtis expands footprint in Arizona 

PHOENIX – Virtis Health has opened three new ambulatory infusion centers (AICs) in in Flagstaff, Gilbert and Sun, Ariz., bringing its total number of locations in the state to seven. “Our Virtis Health Arizona infusion centers offer patients greater privacy and a place where they can comfortably and easily receive specialty infusible and injectable medications,” said Kathy Mayberry, regional business leader at Virtis Health Arizona. “We bring a highly personalized, quality care model and experienced clinical team, coupled with customized, dedicated service to patients and physicians. Now, with our seven strategically located AICs, we are capable of caring for patients statewide.” Virtis also has infusion center locations in Illinois, Wisconsin, Ohio and Texas, offering a range of therapies for patients with autoimmune disorders, including chronic inflammatory demyelinating polyneuropathy (CIDP), multiple sclerosis and myasthenia gravis.   

Ascensia program increases access to CGM 

BASEL, Switzerland – Ascensia Diabetes Care has launched a Patient Assistance Program to reduce out-of-pocket costs for its Eversense Continuous Glucose Monitoring System. “Our fundamental goal at Ascensia is to simplify and improve the lives of people living with diabetes through technologies that facilitate better outcomes and reduce the burden of managing the condition,” said Mary Puncochar, head of Ascensia’s Region US. “We therefore want to be able to offer Eversense to as many people as possible and we believe that over half of the people using insulin in the US could be eligible for our Patient Assistance Program.” Per the program, eligible patients pay the first $100 of their out-of-pocket costs, and Ascensia will then cover up to $300 of the remaining balance for each 90-day sensor. Overall, the program has the potential to save eligible Eversense users up to $1,200 per year. Ascensia last year partnered with Senseonics to distribute its implantable CGM systems, including the Eversense and Eversense XL. 

Senate honors United Spinal 

KEW GARDENS, N.Y. – The U.S. Senate has formally recognized the United Spinal Association on its 75th anniversary by passing a resolution, S. Res. 278, highlighting key moments in the organization’s history. One such moment: In 1948, United Spinal members advocated for and helped pass the first accessible housing bill in the United States, which helped to build homes for paralyzed veterans. “The resolution formally honors United Spinal’s continued role in supporting and advocating for people with spinal cord injuries and neurological disorders, as well as all veterans,” the organization stated. “It recognizes United Spinal’s proven programs and services, the resources, one-on-one assistance and peer support we provide, and the advocacy work we do on behalf of the SCI/D, disability and veterans communities.” United Spinal thanked Sens. Bob Casey, D-Pa., and Jerry Moran, R-Kan., for sponsoring the resolution. 

United Spinal amplifies ‘Voices’ 

KEW GARDENS, N.Y. – The United Spinal Association has launched a campaign, “Voices United,” to amplify the strengths and talents of its membership community as part of the group’s celebrations of its 75th anniversary. “The success of our diverse membership base in overcoming the challenges of living with spinal cord injuries and disorders and, ultimately, regaining their independence, propels United Spinal’s mission,” said Brook McCall, senior director of United Spinal’s Tech Access Initiative. “Every day, our members prove that there are significant benefits to building an inclusive world that embraces their abilities.” The campaign offers United Spinal members and partners the opportunity to share their stories and selfies on a digital map showcasing the organization’s reach across the country. The map also features information on United Spinal’s chapters, peer support groups and programs. 

Report Card: Wide disconnect between those with mobility challenges, general public 

WINAMAC, Ind. – Only 23% of the members of The Driving Force, an online community of people with mobility impairments and their caregivers, believe their challenges are fairly accommodated, compared to 61% of the general public, according to the second-annual “Drive for Inclusion Report Card” from BraunAbility. Seventy nine percent of members believe the design and development of accommodations within the businesses they frequent is most lacking, compared to 37% of the general public. Additionally, those with mobility disabilities are two times more likely than the general population to see a lack of inclusion of people with mobility challenges when accommodations for that audience are being designed, according to the Report Card. BraunAbility surveyed the general public and members of The Driving Force to identify obstacles to inclusion based on perceptions – or misperceptions – between the general public and those with mobility disabilities. 

Senators introduce bill backing disposable NPWT 

WASHINGTON – Sens. Richard Burr, R-N.C., and Michael Bennet, D-Colo., have introduced a bill to put disposable negative pressure wound therapy devices on a level playing field with non-disposable NPWT devices. Specifically, the Better Wound Care at Home Act would standardize payment methodology nationally by applying a neutral wage index for payments made to home health agencies; clarify that payments to HHAs for disposable NPWT devices are to be made for the device itself, not accompanying professional services; and reduce administrative burdens by streamlining billing forms. “The need for at-home treatment has been underscored during the COVID-19 pandemic,” Bennet said. “We can improve the health and quality of life of our seniors by giving them access to appropriate care that incorporates cutting-edge technology from the comfort of their homes. This bipartisan legislation will help provide patients with the best, highest-quality care in their own homes, while reducing hospital visits and health care costs.” Reps. G.K. Butterfield, D-N.C., and Markwayne Mullin, R-Okla., introduced companion legislation in the House of Representatives on April 5. 

Waystar to buy Patientco 

LOUISVILLE, Ky. – Waystar, a provider of health care payments software, has announced plans to acquire Patientco, a provider of omnichannel patient payments, communications and engagement software. Together, the two companies will offer patients consumer-friendly experiences when paying medical bills, while simplifying how providers receive and process payments both before and after care delivery, according to a press release. “Waystar’s purpose is to simplify health care payments,” said Matthew Hawkins, CEO of Waystar. “Patientco is the perfect partner for Waystar because it helps us transform the patient financial experience and significantly reduce wasteful administrative costs, which are the biggest pain points in health care. Patients are more responsible for their health care expenses than ever before, and they expect modern, consumer-friendly interactions from health care providers an insurers.” Formed in 2017 through the combination of revenue cycle market leaders Navicure and ZirMed, Waystar has integrated several technologies onto its cloud-based platform. Other recent acquisitions include eSolutions, a leading provider in Medicare-specific revenue cycle technology solutions; Recondo, a patient estimation and prior authorization AI and RPA-driven technology; and Ovation, an AI-powered claims monitoring tool. Waystar is backed by EQT, CPPIB and Bain Capital; Patientco is backed by Accel-KKR and The Blue Venture Fund. 

Short take: Wooster Products 

Wooster, Ohio-based Wooster Products, which makes anti-slip safety stair treads and walkway products, has appointed Core Products as its new representative for the state of Oregon. Core Products, which is based in Hawaii and led by industry veteran Brad Couden, CDT, will represent the full line of Wooster Products…