In brief: Telehealth extended, home infusion bill re-introduced, accessories coding revised 

WASHINGTON – Congress has passed a continuing resolution that includes an extension of telehealth flexibilities and reimbursement policies through Sept. 30, 2025, VGM has reported. 

“These measures represent a commitment to maintaining the momentum of telehealth adoption, which surged during the COVID-19 pandemic,” VGM stated in a bulletin. “By extending these provisions, Congress aims to bridge the gap in health care access for diverse populations, from rural communities to urban centers. As telehealth continues to evolve, these policies underscore the growing recognition of virtual care as an integral component of modern healthcare delivery.” 

Here is the breakdown of the telehealth-related provisions in the CR: 

• Waiver of geographic requirements: Medicare beneficiaries can now access telehealth services regardless of their physical location, removing barriers for those in rural or underserved areas.  
• Expanded originating sites: Patients can receive telehealth care from the comfort of their homes or other non-traditional settings, making health care more convenient and accessible.  
• Broader practitioner eligibility: More health care professionals are now eligible to offer telehealth services, increasing the pool of providers and enhancing access to care.  
• Support for underserved communities: Federally Qualified Health Centers (FQHCs) and Rural Health Clinics (RHCs) are authorized to continue providing telehealth services, an essential resource for rural and underserved populations.  
• Mental health services: The in-person visit requirement for telehealth mental health services has been postponed. Additionally, RHCs and FQHCs can extend their telehealth mental health offerings, ensuring continuity of care in this critical area.  
• Audio-only telehealth services: The authorization for audio-only telehealth services has been extended, which is particularly beneficial for elderly patients or those without access to video capabilities.  
• Telehealth for hospice care: Healthcare providers can use telehealth for face-to-face encounters required before recertifying eligibility for hospice care, streamlining care for terminally ill patients. 

Kyle Zebley, executive director of ATA Action, the advocacy arm of the American Telemedicine Association, reacted: 

“We appreciate Congress taking action to prevent a lapse in these vital telehealth flexibilities. While we would have preferred a longer extension, this step ensures uninterrupted access to telehealth services for patients and clinicians, as we continue working toward permanent solutions that reflect the needs of modern health care.” 

Re-introduced legislation seeks to modernize home infusion benefit 

WASHINGTON – Members of the House of Representatives and the Senate have re-introduced legislation that would create a complete home infusion benefit for Medicare beneficiaries with conditions that require an infusion pump. 

The “Preserving Patient Access to Home Infusion Act” would: 

• Provide technical clarifications that would remove the physical presence requirement, ensuring payment regardless of whether a health care professional is present in the patient’s home; 
• Acknowledge the full scope of professional services and maintain the current reimbursement rate for in-person nursing visits for at least five years; and 
• Expand the availability of home infusion to additional patients by making IV anti-infectives available under the home infusion benefit.   

“Home-based infusion services are a vital component in improving access to life-sustaining IV treatments and enhancing the quality of life for patients and their families, while adding capacity to the health care system,” said NHIA President & CEO Connie Sullivan, BSPharm. “Passage of the Preserving Patient Access to Home Infusion Act will modernize Medicare’s coverage of home infusion, bringing it in line with the commercial sector, and finally achieve Congress’ intent with creating the benefit.” 

The legislation was introduced by Reps. Vern Buchanan, R-Fla., Diana Harshbarger, R-Tenn., Rep. Debbie Dingell, D-Mich., and Terri Sewell, D-Ala., in the House, and Sens. Mark Warner, D-Va., and Sen. Tim Scott, R-S.C., in the Senate. 

The home infusion benefit, first launched in 2019, has failed to achieve is promise of delivering patient access to home infusion, say supporters of the legislation. They cite data from CMS show that several states haven’t registered a single home infusion service visit and that fewer than 1,500 Medicare beneficiaries are receiving home infusion services each calendar quarter. 

For more information on the legislation, go here. 

• Related: Earlier this year, stakeholders, with feedback from the Congressional Budget Office, were working with lawmakers from both sides of the aisle to modify previous bills to improve Medicare’s home infusion benefit. 

DME MACs change coding for wheelchair accessories 

WASHINGTON – CMS is revising E1028 and creating three new HCPCS codes for wheelchair accessories effective April 1. 

A joint DME MAC publication announced the following updates: 

• Revise existing HCPCS Level II code E1028, "Wheelchair accessory, manual swingaway, retractable or removable mounting hardware for joystick, other control interface or positioning accessory" to instead read "Wheelchair accessory, manual swingaway, retractable or removable mounting hardware, other" 
• Establish a new HCPCS Level II code E1032, "Wheelchair accessory, manual swingaway, retractable or removable mounting hardware used with joystick or other drive control interface." 
• Establish a new HCPCS Level II code E1033, "Wheelchair accessory, manual swingaway, retractable or removable mounting hardware for headrest, cushioned, any type" 
• Establish a new HCPCS Level II code E1034, "Wheelchair accessory, manual swingaway, retractable or removable mounting hardware for lateral trunk or hip support, any type" 

The DME MACs noted that E1032, E1033 and E1034 are in the capped rental payment category. To avoid potential overpayments, they say, items previously coded and billed under E1028 that are still in the capped rental period should continue to be billed under code E1028 rather than switching mid-capped rental to the new HCPCS code. 

At press time, the fee schedules for the new codes were not posted. 

• Go here for the official announcement. 

Wasem’s Pharmacy expands into home medical 

CLARKSTON, Wash. - Wasem’s Pharmacy & Home Medical has expanded into the home medical space, offering mobility products and personalized service to meet the needs of seniors and individuals with mobility needs. The company now offers a curated selection of mobility products, including lift chairs, power scooters and wheelchairs. "What sets Wasem's apart from typical furniture stores offering standard lift chairs or Amazon and other online retailers is our commitment to quality, durability and exceptional service," a company spokesperson said. "Our lift chairs, power scooters and wheelchairs are built to last, featuring superior craftsmanship and offering longer warranties compared to lower-end brands. We also service all our products, which is something most other retailers don't provide. Plus, we have an expert staff ready to help customers select the perfect mobility scooter or lift chair for their needs." Wasem’s, a family-owned, independent company, serves Clarkston and Lewiston communities. Its pharmacy offers traditional retail prescriptions, as well as home infusion, sterile compounding solutions and vaccines. 

ACHC names new finance exec 

CARY, N.C. - The Accreditation Commission for Health Care has appointed Jonathan Kennedy as vice president of finance and corporate services after serving as interim vice president of finance. In this role, he will oversee key corporate service functions, including accounting and finance, budgeting, strategy, human resources, corporate communications and information technology. “We are thrilled to officially welcome Jon to the ACHC leadership team,” said José Domingos, president and CEO of ACHC. “During his time as interim vice president, Jon has demonstrated outstanding leadership, financial expertise, and a strong ability to foster collaboration across our organization. His extensive experience in financial strategy and client relations will be invaluable as we continue to enhance our services and support our partners with excellence.” Kennedy brings more than 30 years of experience in financial leadership across health care, technology and service-based industries. His career includes senior leadership roles across various industries, including overseeing the North and South American finance shared service operations of the world’s largest clinical research organization (IQVIA, formerly Quintiles). 

FODAC to host fundraiser 

STONE MOUNTAIN, Ga. – Friends of Disabled Adults and Children will host its annual Run, Walk ‘n’ Roll on May 3 at Stone Mountain Park’s Railroad Pavilion to bring together people of all abilities for a “movement that makes a difference.” The event encourages people to move in their own way – whether it’s running, walking or rolling – to raise funds for FODAC’s HME Program, which provides mobility aids at little to no cost for individuals in need. Recipients of equipment include the family of a five-year-old girl who, after surgery for hip dysplasia, needed a specialized walker. When they were told it would take several months for insurance to approve the item, they called FODAC. “(Bryan, FODAC’s certified OT and ATP) is very proactive and he understands the pain patens go through trying to navigate the health care system,” the family said. “He called us back in a few hours and told us he had a walker for us. He gave us hope that day.” This year, as part of the event, FODAC is offering the first 100 people to pre-register and check in at the event a free pass to Stone Mountain Adventure. Sign up by May 2. 

Wayne Pharmacy transitions to Wayne Medical 

GOLDSBORO, N.C. – Wayne Pharmacy has transitioned to Wayne Medical and Mobility Supplies Respiratory Home Care, dropping its pharmacy services after 53 years. The company posted to its Facebook page: “After 53 years of serving Goldsboro and the Wayne County Area, we have decided to close our pharmacy. Patients with an active prescription can visit any Goldsboro-based Walgreens, and they will be able to assist you. The Wiggins Family truly appreciates all of our customers’ patronage over the years! Thank you so much for giving all of us the opportunity to serve your pharmacy needs. For medical equipment and supplies, mobility supplies, wound care supplies, incontinence supplies, compression socks, braces, and oxygen supplies, we are still open. Call 919-735-6936.” In addition to Goldsboro, the company says it has locations in Kenansville, N.C. (Duplin Medical Supply), and Smithfield, N.C. (Johnston Medical & Surgical Supply). 

CMS looks to save $750M with closures 

WASHINGTON – The CMS Innovation Center has announced that it will end four models early by Dec. 31, 2025. The models: Maryland Total Cost of Care (2019-26), Primary Care First (2021-26), ESRD Treatment Choices (2021-27) and Making Care Primary (2024-34). The agency is also considering options to reduce the size of the Integrated Care for Kids (2020-26) awards or make other changes to the model. Additionally, it will no longer pursue two previously announced but not yet implemented models: Medicare $2 Drug List and Accelerating Clinical Evidence. CMS estimates a savings of almost $750 million by ending these selected models early. It says participants should expect follow-up communication with timelines, technical assistance and other information regarding the wind-down and close-out. 

• Read the full announcement here. 

Noridian re-awarded DME contract 

WASHINGTON – Noridian Healthcare Solutions has announced it has been re-awarded the $142 million DME Medicare Jurisdiction A contract. It will continue to administer claims processing for DMEPOS for Medicare beneficiaries that reside in the District of Columbia and 11 states (Connecticut, Delaware, Maine, Maryland, Massachusetts, New Hampshire, New Jersey, New York, Pennsylvania, Rhode Island and Vermont). “Since 2015, Noridian has served the suppliers and beneficiaries of JA,” said Noridian President and CEO Jon Bogenreif. “This re-award reflects Noridian’s exceptional performance and a well-established commitment to eliminating administrative barriers and enabling access to health care.” Noridian will continue to support the CMS Medicare fee-for-service (FFS) health services in JA by providing claims processing and payment services related to supplier billing. It will also provide outreach and education, process appeals and respond to complex inquiries from congressional offices, CMS and beneficiaries. Jurisdiction A includes more than 20,000 DME suppliers and annually processes more than 11 million claims for Medicare beneficiaries. 

Soleo Health expands in Indiana 

FRISCO, Texas, and FORT WAYNE, Ind. – Soleo Health has opened an ambulatory infusion suite in Fort Wayne, Ind., further expanding its presence in the Indiana marketplace. The suite is close to major health care facilities serving the broader Fort Wayne area and is staffed with experienced registered nurses who care for patients with complex, rare or ultra-rare conditions. “We are excited to offer additional services in the Fort Wayne market,” said Craig Vollmer, chief commercial officer at Soleo Health. “An increasing number of patients and providers are finding that alternate sites of care – such as an AIS – can seamlessly, easily and conveniently address their needs. By further cementing Soleo Health’s presence in Indiana with our new AIS and complementing our home infusion service offering, we will demonstrate to both patients and providers across the greater Fort Wayne community our experience and clinical excellence, as well as our abilities in simplifying complex care.” Soleo Health has 26 pharmacy locations with national nursing coverage and pharmacy licensure in 50 states. It is accredited by URAC, ACHC with Distinction in Rare Diseases and Orphan Drugs, and the National Association of Board of Pharmacy. 

• Related: Court Square Capital Partners and WindRose Health Investors recently announced the closing of a jointly controlled investment in Soleo Health.   

MFCUs boast recoveries 

WASHINGTON – Medicaid Fraud Control Units recovered $3.46 for every $1 spent in fiscal year 2024, according to an annual report from the Office of Inspector General. Their activity resulted in 1,151 convictions – 817 from fraud and 224 from patient abuse or neglect – and 1,042 individuals or entities being excluded from federally funded programs. It also resulted in 493 civil settlements and judgements. MFCUs recovered $1.4 billion in FY24 - $961 million from criminal recoveries, the highest amount over a 10-year period, and $407 million from civil recoveries. The report highlighted, as an example of criminal fraud, a scheme that involved billing the Medicaid program for DME such as knee braces for elderly and disabled patient who did not receive these items. A federal indictment was issued against the defendant, who was ordered to pay $421 million to CMS. 

• Read the annual report here. 

Fraud roundup: Accreditation, medical necessity schemes 

Manual Delgado, 64, a former contractor for the Board of Certification/Accreditation (BOC), has pleaded guilty to accepting cash bribes and self-dealing as part of a conspiracy to impede and obstruct the lawful functions of the U.S. Department of Health and Human Services and CMS in their administration and oversight of the Medicare program. According to court documents, Delgado, who performed inspections of DME companies to determine if they complied with CMS quality standards, accepted cash bribes from numerous owners of companies to facilitate and expedite the accreditation process so those companies could be enrolled with and bill Medicare.  He also formed DME companies in the names of family members to conceal his own personal interest in the companies and then inspected these companies himself and obtained BOC accreditation and CMS approval. Delgado then sold the companies to others.  The estimated value of the fraudulently accredited DME companies that he inspected was more than $1.4 million. Delgado faces up to five years in prison. Any further proceedings will be set by the court...Shafi Abbas, 57, has been sentenced to one year and one day in prison for engaging in a conspiracy to commit health care fraud and money laundering in connection with DME businesses. Abbas, through his companies Aidmen Medical Equipment LLC and Justright Medical Equipment LLC, fraudulently billed Medicare for DME that was medically unnecessary, unwanted by patients and not prescribed by the medical providers. Abbas also transferred funds, in criminally derived property of a value greater than $10,000, which came from specified unlawful activity, specifically the health care fraud conspiracy. He has been ordered to pay restitution of more than $1.3 million.