In brief: Reimbursement relief, MA guardrails, Numotion pilot
By HME News Staff
Updated 12:47 PM CST, Fri December 6, 2024
WASHINGTON – More than 30 leading patient advocacy organizations have weighed in with congressional leadership to support including provisions from H.R. 5555 and S. 1294 in any legislative package that moves before the end of the year, AAHomecare reports.
In a Dec. 2 letter from the ITEM Coalition, the groups assert that the expiration of 75/25 blended Medicare reimbursement rates on Jan. 1, 2024, has resulted in a “crushing blow to DMEPOS suppliers and providers, threatening to decimate the infrastructure that enables Medicare beneficiaries with disabilities and chronic conditions to manage their medical and functional needs at home.”
The letter comes as congressional leaders negotiate the size and scope of year-end legislative packages, including government funding legislation that must be passed by Dec. 20, AAHomecare says.
Groups like the ITEM Coalition don’t typically address reimbursement issues, focusing on coverage and coding, so the letter speaks volumes about the importance of relief, the association says.
“When reimbursement policies materially impact patient access to care, we feel we must weigh in with our members’ concerns,” the letter states.
Joining the ITEM Coalition is the ALS Association, the Muscular Dystrophy Association, the Spina Bifida Association, United Spinal Association and other well-known national organizations.
Proposed rule would establish more guardrails for Medicare Advantage
WASHINGTON – CMS is proposing changes to the Medicare Advantage (MA) and Medicare Part D prescription drug programs to hold them more accountable for delivering high-quality care for people with Medicare.
In the Contract Year 2026 MA and Part D proposed rule, CMS proposes addressing inappropriate use of prior authorization and internal coverage criteria, including by defining the meaning of “internal coverage criteria” to clarify when MA plans can apply utilization management, ensuring plan internal coverage policies are transparent and readily available to the public. In addition, the agency is working to collect detailed information from initial coverage decisions and plan-level appeals, such as decision rationales for items, services, or diagnosis codes, that will provide a better line of sight on utilization management and prior authorization practices.
“Our loved ones with Medicare deserve care that puts their interests first,” said HHS Secretary Xavier Becerra. “HHS is proposing to improve transparency, accountability, and consumer protections in Medicare Advantage and Part D plans so that everyone receives high-quality care. To achieve that, we want to remove barriers that delay care or deny people services and medications they need to be healthy. In addition, we continue to promote competition for pharmacies and other health care businesses.”
The rule would also increase guardrails on the use of artificial intelligence (AI) to protect access to health services.
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To review or comment on the CY 2026 MA and Part D proposed rule during its 60-day public comment period, visit the Federal Register . Comments must be submitted no later than Jan. 27, 2025.
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For more information on the CY 2026 MA and Part D proposed rule, view the fact sheet.
AOPA’s Lee to step down
ALEXANDRIA, Va. – Eve Lee will step down as executive director of the American Orthotic and Prosthetic Association, effective Jan. 22, 2025, to start a new role as CEO of the Society of Interventional Radiology.
The Executive Committee of AOPA’s board of directors is working with Lee to develop a transition plan that will be communicated to members prior to the end of the year.
“Over the past six years Eve has been an integral part of our organization, leading with vision, passion, purpose, and an unwavering commitment to advancing AOPA and the O&P profession,” said AOPA’s board of directors in an announcement on its website. “We are grateful for Eve’s dedicated service, her contributions to fulfilling AOPA’s mission, and the increased value she has created for our members, all of which will have a lasting impact on AOPA and O&P’s future.”
Under Lee’s leadership, AOPA has achieved significant milestones, including:
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Continuously maintaining a positive forward-thinking outlook and demonstrating effective leadership while navigating the COVID pandemic-related challenges experienced by our association and members. This past September AOPA’s National Assembly achieved pre-pandemic levels of attendance and member engagement.
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The development and execution of an innovative five-year strategic plan that is leading AOPA and the O&P profession into conversations about the broader health care landscape. Lee embraced the importance of pursuing value-driven and data-based care, and AOPA members are beginning to see the positive impacts of this investment.
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Increasing collaboration and strengthening AOPA’s relationships with the O&P community, policy makers and allied health professionals. These collaborations will continue to benefit AOPA members, the O&P profession and the individuals served.
NCART celebrates retiring CRT leaders
WASHINGTON – NCART recognized three industry advocates who will be retiring from the NCART board of directors and from their companies. They are:
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Greg Packer of US Rehab: “Greg has been a committed and determined advocate for the CRT industry for decades,” said Ike Issacson, senior vice president of government & regulatory relations, VGM. “His work was personal to him, and anybody who worked with him knew that he would do anything he could for those in the industry.
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Doug Westerdahl of Numotion: “His unwavering dedication and leadership have certainly set a high standard for us all,” said Mickae Lee, president of NCART. “His vision and guidance have been invaluable, and his legacy will continue to influence the entire CRT community long into the future.”
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Tom Whelan of ETAC: “I know of no one in our industry as knowledgeable on so many things as Tom,” said Doug Munsey, president of ETAC. “I also do not know anyone else with his lateral thinking abilities.”
“To all three of these fine gentlemen, we raise a glass and thank you for all you have done for this industry and all the people who live better lives because of your passion and dedication,” said Wayne Grau, executive director, NACRT. “We will miss you but will never forget you!”
Cruise, Numotion partner on WAV pilot
HOUSTON – Cruise, a leader in autonomous vehicle technology, has partnered with Numotion to introduce a six-month wheelchair-accessible vehicle (WAV) pilot program in Houston. The program offers free, dependable transportation for qualifying Numotion customers, enabling travel to and from the company’s Houston facility for essential wheelchair repairs. “Numotion is excited to partner with Cruise to offer a seamless and convenient solution for wheelchair users in the Houston area,” said Mike Swinford, CEO of Numotion. “By providing transportation to and from repair appointments, we're alleviating a significant stressor and providing a way for our customers to receive their service and repair faster.” In close collaboration with Numotion and General Motors’ Accessibility Center of Excellence, the program utilizes two human-driven award-winning Chevy Traverses, upfitted with wheelchair-accessible modifications by BraunAbility. Cruise has developed training for WAV drivers to ensure they can safely and effectively assist riders using the service. "Accessibility is core to our mission at Cruise,” said Craig Glidden, president and chief administrative officer at Cruise. “This pilot program with Numotion is doing more than providing accessible rides – it’s about empowering people in the community with greater mobility and independence, while also building learnings to better our service in the future.”
Coloplast divests skin care biz
MINNEAPOLIS – Coloplast has divested its core Skin Care business to focus on its Advanced Wound Care business. Revenue from the core Skin Care business amounted to around DKK 400 million in FY 2023/24, with an operating profitability level significantly below the group EBIT margin. Coloplast’s FY 2024/25 financial guidance of organic revenue growth of 8% to 9% and an EBIT margin before special items of around 28% is unchanged and already includes the divestment. This simplification of the portfolio will benefit the operating profitability of Advanced Wound Care and accounts for the majority of the around 30 basis points positive impact on the group EBIT margin as highlighted in the FY 2023/24 earnings release. The transaction was completed on Dec. 3. Specific terms of the transaction have not been disclosed.
AAH on the hunt for next Homecare Champion
WASHINGTON – AAHomecare is accepting nominations for the Van G. Miller Homecare Champion Award, which celebrates individuals who have made significant contributions to improving patient care, advancing the industry and advocating for the needs of home care providers. To be considered for the Homecare Champion Award, nominees must demonstrate exceptional leadership, innovation and advocacy within the industry. Nominees can include industry professionals, caregivers, advocates and others who have made a significant and lasting impact on HME. To see a list of past award recipients, including Joel Marx of Medical Service Company in 2024, go here. Visit aahomecare.org/Homecare-Champion-Nomination to submit your nomination by January 17, 2025.
AAH makes tariffs top priority in coming months
WASHINGTON – AAHomecare hosted a call recently with 40 manufacturing stakeholders to discuss the potential impacts of new tariffs under president-elect Donald Trump and the industry’s response. Trump has signaled that he will impose tariffs on products from Mexico, Canada and China in 2025. “The hour-long call included an overview of the situation, as well as potential avenues to prevent or minimize the effects on our industry, such as engaging with the Commerce Dept. and Capitol Hill, participating in coalitions, developing messaging on public health impacts, and media outreach,” the association stated. “New tariffs on products from China would be particularly impactful on medical device and home medical equipment manufacturers, as many of these products or components for them are made there.” AAHomecare has made the industry’s response to the tariffs a major priority of the association in the coming months, as increased costs from tariffs on HME are not easily passed on to consumers, making them difficult for providers and manufacturers to absorb.
Analysis: NHIA’s changes could save billion-plus
WASHINGTON – An independent analysis by Magnolia Market Access estimates that changes proposed by NHIA to the Preserving Patient Access to Home Infusion Act to expand Medicare Part B home infusion therapy services coverage to anti-infectives and to bundle payments for disposable supplies with the services payment would generate significant savings for Medicare. On the IV anti-infective policy, Magnolia provides two savings estimates based on the magnitude of patients that would migrate from hospitals to home infusion under this coverage expansion: $500 million over 10 years if 25% of patients shift to home infusion, and $1 billion over 10 years if 50% of patients shift to home infusion. On the bundling policy, Magnolia provides a savings estimate that is consistent with the Congressional Budget Office of approximately $400 million over 10 years. Introduced in 2023 in both the Senate and the House of Representatives, “The Preserving Patient Access to Home Infusion Act” would include pharmacy services as part of the home infusion therapy benefit under Medicare, covering everything from assessments to drug preparation and compounding to care coordination and documentation. The bills, S. 1976 and H.R. 4104, would also direct CMS to pay 50% of the nursing rate on days when home infusion is provided, even when a nurse is not present.
Belluscura looks to wound care market
LONDON - Belluscura has entered into a joint venture with Separation Design Group and an undisclosed major medical device company to develop oxygen-based wound care solutions. The collaboration aims to address the growing wound care market through innovative treatments, including continuously diffused oxygen (CDO) therapy, which has shown potential in healing chronic wounds such as diabetic foot ulcers. The joint venture, in which Belluscura will act as the original equipment manufacturer (OEM), is backed by the major medical device company's commitment to fund product development, clinical trials and distribution following regulatory approval. Bob Rauker, CEO of Belluscura, said the venture has the potential to leverage the company’s technology across broader health care applications, addressing the substantial and growing need in the wound care market. The first clinical study is expected to begin outside the United States in early Q2 2025.
El Paso woman sentenced in fraud case
EL PASO, Texas – An El Paso woman was sentenced to 60 months in prison for conspiracy to commit health care fraud. Edelmira Marquez, 59, engaged in fraudulent billing practices as the owner of Marquez Medical Supply, a durable medical equipment company located in El Paso. Marquez’s scheme involved substituting and providing lesser valued items to Medicaid and Medicare beneficiaries/patients, then billing Medicaid and Medicare for the greater valued items. The items were primarily continence supplies, including adult diapers, wipes and bed liners. Marquez made her initial court appearance Jan. 19, 2024, and was released on bond. She pleaded guilty to the single count on March 7. Upon sentencing, Marquez was remanded into federal custody. Marquez was also fined $20,000 and ordered to pay $1.7 million in restitution to Medicaid. The FBI and the Texas Attorney General Medicaid Fraud Control Unit investigated the case.
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