What You Should Know about your Home Oxygen Therapy

What You Should Know about your Home Oxygen Therapy

Medicare's New Payment Policies for Care

HMEprovider.com is an online program that works to connect the aging in place and their loved ones with a LOCAL medical equipment provider to fullfill their needs. We have received several contacts as of late from consumers either wanting to change their current oxygen provider or are looking to move and need to locate a new provider. Consumers are running into several obsticles and therefore it seemed like a good time to share some patient education. Many of the challanges patients are facing are the result of Medicare's new regulations in relationship to oxygen services. Background The Deficit Reduction Act of 2005 capped reimbursement for Medicare home oxygen after 36 months of use. In many cases, the artificial cap prevents oxygen providers from receiving reimbursement for the entire period or your medical necessity to receive oxygen, which imposes financial hardship on homecare companies. Moreover, the policy of capping payment jeopardizes your access to continued care, as well as the quality of care that you deserve. On October 30, 2008, Medicare issued a final rule outlining its payment policy for oxygen therapy that is provided after 36 months. These onerous, confusing, and poorly conceived rules established minimal and inadequate payment levels, as well as unprecedented obligations that are impeding the provision of quality care to our patients. Under the Medicare rule, the original home oxygen provider must continue to provide, without any payment, for a two-year period following the reimbursement cap:

• Unscheduled service and maintenance visits,
• 24 hour, 7 day a week emergency care,
• Equipment repairs, and
• Oxygen supplies and accessories.

The rule also establishes inadequate payment levels for scheduled maintenance and service – equal to two 30-minute visits annually. Patients and providers have begun seeing the detrimental effects of the recently implemented Medicare oxygen rule. The following examples are occurring across the country for oxygen patients who are at or nearing the 36-month rental cap:

• A patient who would like to move out of the original provider's service area, but the provider cannot find a company in the new area that is willing to provide home oxygen therapy in the new location, due to the minimal payment levels.
• A hospital that is looking to discharge a patient to a different area of the country is unable to find an oxygen provider and therefore cannot discharge the patient, forcing the Medicare program to pay for additional time spent in the hospital.
• A patient who would like to switch providers cannot find another company willing to provide home oxygen therapy, due to minimal payment levels.
• A company is going out of business and patients cannot find new home oxygen providers, again, due to minimal payment levels.

As you know, home oxygen is a critical, life-sustaining medical treatment. It is prescribed to nearly 1.5 million Medicare patients annually who suffer from respiratory illnesses such as chronic obstructive pulmonary disease (COPD). COPD is a progressive, incurable disease that causes irreversible loss of lung function. Although medications have not been shown to be beneficial in reversing lung damage, home oxygen therapy, when properly prescribed and maintained, has been shown to slow the progress of this degenerative disease. A home oxygen company provide far more than just equipment. They are also front-line caregivers. They educate you on the proper use of their equipment, answer your questions, make repairs and adjustments, and ensure that you are receiving the prescribed amount of oxygen. Additionally, they are one of the primary points of contact for many of our patients. They take calls at all hours and drive long distances to make sure that patients receive the care they need. Without reimbursements for these visits, oxygen providers will not be able to afford to provide the current level of care for many of their patients. What you can do as a Medicare beneficiary Contact your members of Congress to tell them that they must restore reimbursement for oxygen for the period of medical necessity, regardless of the time frame. Be sure to contact your representative and both of your senators. To contact them, dial the U.S. Capitol Switchboard at 202-224-3121. If you are not sure who your representative and senators are, provide the operator with your ZIP Code. The operator will use your ZIP Code to connect you to your member of Congress. (Please note that in order to reach your representative and your senators, you will need to make a total of three calls: one to your representative and one each to both of your senators.) Congress should advise CMS to modify the existing post-36 month oxygen payment policies to address serious shortcomings that are creating hardships for both oxygen patients and providers. The HME community requests that Congress consider taking additional action if CMS is unresponsive in fixing the payment rules. Without immediate changes to the Medicare oxygen policies, patient care will be compromised and Medicare costs will increase.