Legal challenges may delay Medicare's efforts to start a
for certain durable medical equipment, prosthetics, orthotics, and
Centers for Medicare & Medicaid Services (CMS) officials
plan to start the program July 1 in the nation's largest 10
metropolitan statistical areas, including the Dallas-Fort
Worth-Arlington area. The program would require Medicare patients
whose physicians prescribe DMEPOS to obtain the items from a
in the area, or they might have to pay for it themselves. This
includes common items such as oxygen supplies and equipment,
wheelchairs, walkers, mail-order diabetic supplies, and hospital
Plans are to expand it to the Austin-Round Rock, San Antonio, El
Paso, Houston-Sugar Land-Baytown, Beaumont-Port Arthur, and
McAllen-Edinburg-Mission areas sometime in 2009.
reports that two lawsuits and congressional intervention seek to
block CMS from implementing the plan.
says the American Association for Homecare contends in a
Washington, D.C., lawsuit that CMS "failed to specify the financial
standards that were grounds for eliminating providers in the first
round of bidding and that the agency arbitrarily downsized its
definition of a small provider, a status that confers special
treatment under the program."
It said a similar case was filed in a Dallas federal court on
behalf of five providers and two consumers.
A third case in Cleveland asks for a preliminary injunction to
block the program.
reported, a letter signed by 40 senators asks Senate leaders to
support legislation that would delay the program.
If the program goes forward, CMS urges physicians and other
referral agents (i.e., providers who refer Medicare patients for
DMEPOS supplies and services) in the competitive bidding areas to
be familiar with the requirements of the program. Physicians play a
critical role in helping Medicare patients select DMEPOS suppliers
that can meet the patient's needs as well as the new DMEPOS
CMS has developed a
Tip Sheet for Referral Agents
] to help physicians answer questions their patients may have. It
also plans to mail physicians in the Medicare program a
comprehensive packet on the program around June 20. The packet will
include tip sheets, frequently asked questions, and other relevant
documents to assist physicians in helping their
patients navigate the DMEPOS program.
, June 16, 2008