In brief: UHC delays Synapse agreement, NCPA files cyberattack lawsuit & more 

MINNEAPOLIS – UnitedHealthcare recently notified HME providers that it is delaying the implementation of its new capitated arrangement with Synapse Health for standard DME in Georgia and North Carolina, AAHomecare has reported. 

The arrangement, which impacts the insurer’s Medicare Advantage plan members enrolled in HMO and PPO plans in the two states, will now go into effect Sept. 1 instead of Aug. 1 to allow more time for providers to familiarize themselves with new processes and requirements, the association says. 

AAHomecare recommends that providers thoroughly read and understand the requirements and standards laid out in Synapse Health’s DME Provider Handbook. The association highlighted these in particular: 

Section 2 – DME Performance Standards – page 6: 

• Maintain 24−hour on-call coverage seven days per week and respond to Synapse Health within 30 minutes of call, including after normal business hours, weekends and holidays. 

• Do not attempt or collect member/patient copayment, coinsurance or deductible amounts. Synapse Health collects all member/patient payments. 

Section 3 – DME Orders & Delivery – pages 6-9: 

• Standard Orders: Providers are required to access, fulfill and respond by accepting or rejecting the order within two hours of the email notification.  
• STAT Orders/Hospital Discharge Orders: Providers are required to access, fulfill and respond by accepting or rejecting the order within one hour of the email notification. 
• STAT Orders: Orders that have the checked “STAT” indicator box are considered STAT and require 1-2 hour or, up to, a 4–6-hour delivery time window and are dependent on clinical need. In the event the provider cannot fill the order on the indicated day, the provider will message Synapse Health by using the NOTES feature in the Fulfill portal to communicate an alternative date/time when the order can be fulfilled. 
• Urgent Requests: The DME provider has a responsibility to promptly address urgent requests for the maintenance or replacement of durable medical equipment. This typically involves making an in-person visit to the patient's home or residence. During regular business hours, the urgent request will be communicated to the DME provider through the standard order email notification process and by phone. In the case of after-hours urgent requests, Synapse Health will reach out to the DME providers on-call or after-hours contact. The DME provider is required to respond to Synapse Health within 30 minutes of receiving the request and ensure the delivery of the urgently requested durable medical equipment within four (4) hours.  

Section 4 – Patient Transfers – pages 10-11:  

• When a provider becomes subcontracted with Synapse Health, patient care and management shift to Synapse Health as the new provider of record. This transition ensures that patients continue to receive the highest quality of care and services seamlessly under the Synapse Health Network. 

AAHomecare says it met with UHC in late June to discuss the new arrangement and to share the concerns it has received from members in Georgia and North Carolina. 

The association says the new arrangement will impact about 480,000 members in the two states and noted that, if expanded to other states, it could impact millions more. 

• UHC entered into the capitated arrangement earlier this year. 
• Synapse’s Tony Kilgore says the goal of the new arrangement is simplifying the DME process. 
• But providers are finding it hard to see the benefits of the new arrangement, especially from a reimbursement perspective. 

NCPA, providers sue UnitedHealth Group over cyberattack 

ALEXANDRIA, Va. – The National Community Pharmacists Association, along with dozens of providers from multiple states, filed a class action lawsuit July 19 against UnitedHealth Group and its subsidiaries Change Healthcare and Optum for losses resulting from their massive cyberattack earlier this year. 

NCPA and the providers say Change Healthcare failed to take reasonable precautions against a catastrophic breach; mislead them about its network security; and caused massive financial losses for health care providers who were never reimbursed for services and who incurred huge expenses trying to work around the downed system. 

“UnitedHealth Group and its subsidiaries need to be held accountable for their lax security measures and for their failure to provide our members with adequate support and assurances to alleviate the financial losses our members suffered,” said NCPA CEO B. Douglas Hoey. “NCPA was against UnitedHealth’s acquisition of Change from the start. This breach proves that bigger is not better and that consolidation often leads to inefficiencies. Companies are so big they cannot protect every entry point and cannot respond quickly due to internal bureaucracy. The fact issues remain unresolved is a testament to this point. This breach has cost our members a significant amount of money and time and it is still not resolved months later.” 

In February, Change Healthcare was hit with a ransomware attack that brought payment and claims processing across the country to a halt. 

Not only did Change Healthcare, Optum, and UnitedHealth fail to adequately protect data for millions of patients, but when they discovered the breach, they shut the entire system down without providing a workable alternative, leaving thousands of pharmacies without any way to process claims, the lawsuit charges. 

“Because defendants disconnected the Change Platform, many health care providers lost their primary (and in some cases their only) source of claims processing for their patients and did not receive payment,” says the complaint. “Health care providers had to absorb these upfront costs. In addition to the losses from not being paid, many pharmacies had to take out loans or deplete their reserves to buy expensive new software.” 

• The cyberattack had a wide-ranging impact on the HME industry 
• In May, the NCPA was one of many stakeholders who appealed to lawmakers ahead of congressional hearings on the cyberattack 

Reps intro at-home emergency medical services bill 

KINGSTON, N.Y. - U.S. Rep. Pat Ryan, D-N.Y., has introduced a bill that would allow Medicare beneficiaries to receive at-home emergency medical services to treat minor medical incidents and ensure that paramedical and emergency responders receive proper compensation for care rendered. 

Ryan says the “Improving Access to Emergency Medical Services Seniors Act” would reduce the cost of emergency health care by implementing a “treatment-in-place model” that ends a requirement that Medicare beneficiaries be transported to emergency health care facilities for care providers to receive Medicare reimbursement, even for care that could be rendered onsite. 

“Our grandparents, neighbors and friends are safer and healthier because of the dedicated care paramedics and EMTs provide to our community,” Ryan said. “They deserve to be compensated – no matter where they administer care. That’s why I’m proud to co-lead the Improving Access to Emergency Medical Services Act to ensure that our highly trained first responders are fully supported in continuing to save lives and serve our seniors. I will keep fighting for the resources that our first responders need and deserve.” 

Reps. Mike Carey, R-Ohio, Lloyd Doggett, D-Texas, Carol Miller, R-West Va., and Debbie Dingell, D-Mich., joined Ryan in introducing the bill. 

The bill has received support from the National Rural Health Association, International Association of Fire Chiefs, International Association of Firefighters, American Ambulance Association, Congressional Fire Service Institute, National Association of Towns and Townships and the National Association of Emergency Medical Technicians. 

The full text of the bill is available here. 

Numotion named Best Place to Work 

BRENTWOOD, Tenn. – Numotion has been recognized as a Best Place to Work for Disability Inclusion for the fourth year in a row. This recognition honors the company’s commitment to fostering an inclusive and supportive workplace for employees with disabilities, it says. "We are deeply honored to receive this recognition once again," said Mike Swinford, CEO of Numotion. "At Numotion, we believe that fostering an inclusive workplace is not just the right thing to do, but it also makes us a stronger, more innovative company. Our team’s commitment to inclusion is a core value that drives our mission to improve the lives of people with disabilities." The foundation for the recognition is the Disability Equality Index (DEI), a comprehensive benchmarking tool that helps companies build a roadmap of measurable, tangible actions that they can take to achieve disability inclusion and equality. It’s a joint initiative of the American Association of People with Disabilities (AAPD) and Disability:IN. "On the 10th anniversary of the Disability Equality Index, we’re extremely proud of the 542 national and international companies that are taking a proactive role in leading progress towards disability inclusion, setting a benchmark for others to follow,” said Jill Houghton, president and CEO of Disability:IN. “Their dedication to fostering inclusive workplaces not only attracts top talent but also drives innovation and creates sustainable performance in today's global market. Together, we are creating a future where everyone can contribute and thrive.” This year, the DEI measured: Culture & Leadership; Enterprise-Wide Access; Employment Practices (Benefits; Recruitment; Employment, Education, Retention & Advancement; Accommodations); Community Engagement; Supplier Diversity; and Responsible Procurement (Non-Weighted). 

Honest Medical donates returned products 

OCEANSIDE, Calf. – Honest Medical has partnered with Happen Ventures to donate thousands of returned, reusable health products to nonprofits serving those in need. Happen Ventures provides reuse services that support environmental sustainability while fostering economic and social benefits. Its most recent donation was to Hope Esperanza, a nonprofit organization located in North Platte, Neb., dedicated to empowering underserved youth and families to enhance health, overcome hardship and promote an overall sense of belonging and well-being. "We understand the importance of giving back to the communities we serve,” said Mike Greenan, CEO of Honest Medical. “Healthy lives are built on strong foundations. This is why we're proud to partner with Happen Ventures and donate to nonprofits such as Hope Esperanza, a fantastic organization that empowers minority and underserved youth and families. Their dedication to providing critical support and educational opportunities aligns perfectly with our values at Honest Medical. We believe everyone deserves a chance to reach their full potential, and we're confident that donations like ours can make a real difference in the lives of the individuals and families that Hope Esperanza and other nonprofit organizations serve." Honest Medical estimates it receives from 100,000 to 200,000 returned, reuseable health products each year. In addition to the donation of products to Hope Esperanza, which included first aid essentials, ostomy supplies and over-the-counter medications, Honest Medical, in partnership with Happen Ventures, has donated a wide range of health supplies to other nonprofits, including Ssubi, Insulin for Life and the Society of St. Vincent de Paul. 

NCPA supports up-and-coming pharmacy students 

ALEXANDRIA, Va. – The National Community Pharmacists Association and the NCPA Foundation have announced that teams of pharmacy students from the University of North Carolina at Chapel Hill, the University of South Carolina, and the University of Texas at Austin have been named finalists in the 2024 Good Neighbor Pharmacy NCPA Pruitt-Schutte Student Business Plan Competition. The three teams will present their business plans in a live competition on Oct. 26 at the NCPA Annual Convention in Columbus, and the winning team will be announced on Oct. 27 as part of the convention’s First General Session. “Having a solid business plan in place makes it easier for pharmacy teams to address whatever challenges inevitably arise in the future,” said NCPA President Lea Wolsoncroft, RPh. “This competition helps pharmacy students feel confident in writing a thorough business plan now, so that they are better equipped as their careers progress.” For first place, the NCPA will give $3,000 to the student chapter and $3,000 to the school in the dean’s name to promote independent pharmacy; for second place, $2,000; and for third place, $1,000. The Student Business Plan Competition, which is supported by Good Neighbor Pharmacy, Pharmacists Mutual Insurance Company and the NCPA Foundation, is the first national competition of its kind in the pharmacy profession and honors two champions of independent community pharmacy, the late Neil Pruitt Sr. and the late H. Joseph Schutte. It aims to motivate students in pharmacy school to create a thought-out plan for either purchasing an existing pharmacy or opening a pharmacy from the ground up, and to prepare tomorrow’s pharmacy entrepreneurs for a successful future. There were 20 entries in this year’s competition.  

Level I of CRT supplier certificate program is live 

LUBBOCK, Texas – iNRRTS has released the first level of the new CRT Supplier Certificate, a program specifically for suppliers of complex rehab technology. “Level I – Foundational Knowledge of Complex Rehab Technology” comprises 10 courses. “Providing CRT is extremely difficult and requires practical experience and knowledge in many different areas,” said Andrea Madsen, ATP, executive director of NRRTS. “When done correctly, providing CRT gives life-changing independence and freedom to those who need and deserve it. Providing CRT incorrectly can cause a great deal of harm and unneeded cost. This program has been carefully designed to make certain that this necessary knowledge has been captured and is presented with online, interactive modules. There are tremendous benefits for everyone, including CRT suppliers, employers, and most of all, our clients.” The program consists of two other levels: “Level II – Expanded CRT Content” and “Specialized Learning; and Level III – Practical Demonstration and Skills Assessment,” which involves students meeting with experienced suppliers. Levels I and II will be available soon. "For more than three years, subject matter experts have worked hard to make sure that a standard of excellence exists focused solely on the provision of CRT,” said Walker, who spearheaded the program. “Broad acceptance of this program can and will improve RTS performance and outcomes for our clients.” 

• Weesie Walker stepped away from her role as executive director of NRRTS earlier this year to focus on completing the CRT Supplier Certification program. 

SageHome announces leadership transition 

ATLANTA – SageHome, a provider of aging-in-place bath remodeling services, has promoted Joe Gorman, co-founder and COO, to CEO. He replaces Brian Hutto, who has been appointed vice chairman of the company’s board of directors to advise the board and executive team on strategic initiatives. “On behalf of everyone at SageHome, I would like to congratulate Joe on his new role,” said Lee Hess, chairman. “As a co-founder of SageHome, he was the obvious successor to Brian – their vision and goals for the business have been completely aligned from the very outset and Joe has played a pivotal role in SageHome’s growth. We expect this transition to be seamless and that SageHome will continue on its successful growth trajectory. Additionally, I am particularly pleased to have Brian Hutto take on the critical role of vice chairman, where his strategic insights will be of greatest benefit to the company.” Gorman, who previously served as COO for Barnes & Noble and GNC, brings extensive experience in leadership, strategy and operations to his new role as CEO, the company says. SageHome partnered with strategic advisors Cairngorm Capital Partners in 2022 to make its first acquisition, New Bath Today. The company also acquired Colorado Living and Safe Showers in 2023, increasing its footprint to a total of 23 states.   

Are you set up to accept EFT from Medicare? 

LUBBOCK, Texas – Brown & Fortunato is advising HME providers to make sure they have downloaded and completed the current version of Medicare’s paper electronic fund transfer (EFT) form by July 24, 2024. In accordance with 42 CFR 424.510(e)(1), and Pub 100-08, Chapter 10, Section 10.6.10 of the Internet-Only Manuals, all providers must receive payments via electronic funds transfer. Providers that do not receive payments via EFT were notified in April of the impending deadline. If providers don’t complete the EFT form by July 24, they will have their billing privileges deactivated, B&F says. The reactivation process requires providers to complete a full 855S form and wait for it to be processed – this can take 90 days or more, with providers unable to submit claims during this time. See your respective contractor’s website for how to submit the EFT: NPE East - Novitas & NPE West - Palmetto GBA. FMI: Email Denise Leard at dleard@bf-law.com. 

AlayaCare tapped by BioMatrix 

NEW YORK – AlayaCare, a global tech platform for home infusion businesses, has been tapped by BioMatrix to bring nursing and agency documentation all in one place, eliminating time spent on administrative tasks, such as faxing and manual uploads. “AlayaCare has all of the necessary nursing operations built into the software that will allow BioMatrix to continue to provide top-notch infusion nursing services,” said David Kinard, vice president of nursing at BioMatrix. “Documenting patient care visits in a user-friendly online form, scheduling nurses within a single software, and automating the billing process will provide better outcomes to the patients and partners they serve. It will also increase productivity and improve visibility and communication for the interdisciplinary care team.” With AlayaCare, BioMatrix can streamline collaboration with subcontracted nursing agencies using the company’s Marketplace, an integrated tool in AlayaCare Cloud, which allows organizations to send and receive patient referrals between providers. BioMatrix, which serves about 10,000 unique patients across the United States, recently announced it has been acquired by Frazier Healthcare Partners, a Seattle-based investment firm. 

Hanger Ventures makes debut investment 

AUSTIN, Texas – Hanger Ventures, a subsidiary of Hanger whose primary goal is to advance orthotics and prosthetics innovation and improve patient outcomes, has made its debut investment in Bionic Power. Canadian-based Bionic Power, developer of active lower body smart orthotic devices that enhance personal mobility, is raising Series A funding, with Hanger Ventures committing as the lead investor. “We look forward to contributing clinical research, along with technical and commercial expertise, to bring innovative solutions to the market that have the potential to meet an unmet clinical need and improve the quality of life for individuals with mobility challenges,” said James Campbell, PhD, president of Hanger Ventures and chief clinical officer of Hanger. Bionic Power devices enhance walking abilities for children and adults with neuromuscular diseases and conditions, including cerebral palsy, spina bifida and stroke. The company will use the investment for product development, clinical trials and go-to-market support. “When we learned about the creation of Hanger Ventures, we felt the opportunity was a great match for Bionic Power’s needs, and the subsequent discussions confirmed our initial impression,” shared Gualtiero Guadagni, PhD, CEO of Bionic Power. “Hanger Ventures is offering far more than capital, and we are eager to leverage their support to expand our business and have a greater impact on those who can benefit from our life-changing products.” 

• Hanger launched Hanger Ventures earlier this year