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VGM Update - 4/14/05 |
Apr 15 2005 8:57AM |
VA: SENATE DEFEATS AMENDMENT TO PROVIDE $1.98B FOR HOSPITALS
The Senate on Tuesday voted 54-46 to defeat an amendment to a military appropriations bill that would
have provided an additional $1.98 billion for Department of Veterans Affairs hospitals, the AP/Los Angeles
Times reports. Sen. Patty Murray (D-Wash.) introduced the amendment as part of an $80.6 billion
emergency appropriations bill for the wars in Iraq and Afghanistan and other military operations.
According to Murray, VA hospitals are overcrowded and require additional funds. "There's a train wreck
coming," she said. Senate Republicans, who opposed the amendment, denied that VA hospitals had such
serious problems and said that the facilities had adequate funds to address emergencies (AP/Los Angeles
Times, 4/13).
TENNCARE: APPEALS COURT RULES JUDGE EXCEEDED AUTHORITY TO BAR CUTS
The 6th U.S. Circuit Court of Appeals on Tuesday ruled that Tennessee officials do not need judicial
approval for their plan to eliminate coverage for 323,000 adults enrolled in TennCare, the state's Medicaid
managed care program, the AP/Boston Globe reports. The court also ruled that a federal judge in January
exceeded his authority when he blocked such cuts (AP/Boston Globe, 4/13). Tennessee Gov. Phil Bredesen
(D) on Jan. 10 announced the plan as an attempt to reduce spending by about $1.7 billion annually. Adults
expected to lose coverage generally have annual incomes that are too high to qualify for traditional
Medicaid. Bredesen also proposed implementing a second phase of restrictions on coverage for about
396,000 adult beneficiaries who would remain in the program. None of the 612,000 children in TennCare
would lose coverage or be subject to coverage changes. U.S. District Court Judge William Haynes, who is
presiding over a 1998 class-action lawsuit challenging TennCare's eligibility requirements for uninsured and
disabled people, in January ruled that Bredesen must seek the court's approval before carrying out the plan.
Haynes also said that he would hold additional hearings to see whether the state had "exhausted all options
to rein in costs" for the program (American Health Line, 1/31). In March, the federal government approved
Bredesen's first phase of cuts (American Health Line,3/25).
VGM Now Offers Complete HIPAA Security Rule Compliance "Toolkit"
Available now on CD; VGM Member price $100
Is your HME or Re-hab facility ready for the HIPAA Security Rule? If not, you should consider ordering
VGM's HIPAA Security Toolkit. This complete policy and procedure manual (CD) will guide all VGM
Group Members through the compliance steps! Homecare providers that were required to comply with the
HIPAA Privacy Rule must now comply with the HIPAA Security Rule by no later than April 20, 2005.
Compliance requires adopting certain administrative, physical and technical safeguards in order to protect
the confidentiality, integrity and availability of electronic health information.
VGM's HIPAA Security Rule Toolkit provides an excellent overview of the Security Rule’s requirements in
terms that all homecare providers can understand, a common sense way to approach the Rule, numerous
resources that can be used by providers in achieving compliance, and complete policy and procedure
templates that providers can edit (in Microsoft Word) and adapt to their facility.
Also included:
* General HIPAA Overview
* Small HME/Re-hab White Paper. (Are you a smaller organization? Start here – you may find your
14 April 2005
implementation procedures much easier!)
* Training PowerPoint: HIPAA's Security Rule - The Final Key To HIPAA Compliance for HME/Re-hab
Providers (suitable training for all levels of management and staff).
* HME/Re-hab Compliance Tracking Job Aid
* HME/Re-hab Application -Safeguard/Implementation Specifications and Suggested Action Items
* Suggested HIPAA Security Rule Preparation and Implementation Checklist
Mark Higley, VGM's Vice President of Development, compiled the training materials. Your order will
arrive in 2 to 3 days with instructions on how to download the CD. All you need is a 2" 3-ring binder and a
printer. (We even include the notebook separators, table of contents, and 3-Ring binder artwork -see graphic
above!) You may order in any of the following ways:
1). Click here to download an order form. Mail the form to VGM @ HIPAA Security Toolkit, P.O. Box
2817, Waterloo, IA 50704, or fax the form to 319.235.9774.
2). Email Mark Higley and include the order form (see above) information.
3). Call Mark at 800.642.6065
Accreditation Questions
MMA quality standards for HME providers are still up in the air, but there are
some things we know for sure.
Most HME providers are aware that the Secretary of the US Department of Health and Human Services
(HHS) is required by the Medicare Prescription Drug, Improvement, and Modernization Act (MMA) of
2003 to establish and implement quality standards for suppliers of items and services described in the Act.
What does this mean to you? The quality standards will be applied by recognized independent accreditation
organizations (to be designated) and suppliers shall be required to comply. HHS has appointed a committee
called the Program Advisory and Oversight Committee (PAOC), which will give advice to the Secretary and
CMS regarding the quality standards. The new quality standards will definitely be more comprehensive
because the Act states they cannot be less stringent than they are already. Also stated in the Act is that the
accreditation organizations are to apply these new standards within 1 year after the Secretary has developed
the new quality standards, but there is no date when the standards must be implemented. The goal of the
standards is to rid the industry of questionable suppliers who abuse the program.
No specific time frame has been given for the recommended implementation. It does state, however, that the
Secretary may establish the quality standards by program instruction or otherwise, to be applied
prospectively. In addition, the Secretary shall designate the accreditation organizations within 1 year after
development. The PAOC last met on March 2, 2005, and committee members were presented with a draft
outline of the quality standards. The committee was informed that proposed regulations would be published
in the Federal Register by summer 2005 with comments reviewed by fall 2005—and final review and
publication in the Federal Register by spring 2006.
In Denial
During the past year, I have had a lot of contact with HME providers across the United States through
consulting, surveying, lecturing at state association meetings, and attending Medtrade conventions. Initially,
the majority of providers I spoke with were in denial of the reality of the HHS mandate. Requirements for
accreditation coupled with unknown new quality standards, reimbursement cuts, price freezes, and
competitive bidding were simply too much to confront. But recently, I sense an acceptance that it is time to
start planning for the impending changes.
Yes, the preparation process will require time and money to improve organizations and comply with
accreditation standards. With professional help, you and your staff may be able to accomplish the task in a
much more timely and cost-efficient manner. A consultant can help by providing a policy and procedure
manual, by educating your staff to new or existing processes, and organizing, restructuring, and identifying
noncompliant areas of your company. Also, consultants can design a plan to monitor and implement
standard changes so your organization remains compliant and ready for accreditation. You don’t have to
remortgage your home to complete the necessary compliance changes for the accreditation process. The fear
of exiting the industry because it is just more than you can accomplish need not be a fear.
Don’t risk losing your Medicare supplier number because you have procrastinated. Putting off the inevitable
could place the accrediting body you have selected in the position of not being able to survey your
organization by the government’s deadline. Your decision to begin the process will decrease the annoyances
you endure and quiet that little voice that says, “You should have started sooner.”
Unanswered Questions
Will one or more of the current accreditation organizations be approved to accredit the 18,000 plus
companies billing Medicare?
• Do the yet-to-be-approved accrediting bodies have the resources to survey and accredit the nonaccredited
companies in the time frame required by HHS?
• Will the corporate compliance program that the OIG encouraged the industry to implement become
mandatory?
• Will external benchmarking be required?
• Will advisory committee input be required for all HME providers?
• What are the 10 metropolitan statistical areas (MSAs) that will comprise the competitive bidding program
to be implemented by 2007? (with 80 MSAs by 2008 and additional MSAs by 2010)?
MEDICARE: FEDERAL CHIEF ACTUARIES SHOULD HAVE CREDENTIALS
The American Academy of Actuaries and four other actuary groups in a letter to Congress have
recommended the passage of a bill that would require chief actuaries hired by the federal government "to be
in good standing with the academy" – a proposal "that's so breathtakingly sensible it immediately demands
support," a New York Times editorial states. The letter seeks to close a loophole in federal law that allows
non-actuaries to serve as chief actuaries for Medicare, Social Security and other federal agencies, the Times
writes (New York Times, 4/12). The letter comes after Medicare chief actuary Richard Foster last year
alleged that former CMS Administrator Thomas Scully ordered him to withhold from Congress a 10-year
cost estimate for the new Medicare law reached before the final House and Senate votes on the legislation in
November 2003. Foster estimated that the Medicare law would cost $534 billion over 10 years -- $134
billion more than a previous estimate by the Congressional Budget Office (American Health Line, 10/1).
According to the editorial, the Bush administration, which "arm-twisted votes out of lawmakers" for the
Medicare law with the CBO cost estimate, "now acknowledges that the cost will be in range" of the Foster
estimate, but "no one has been punished." Foster, rather than "resigning in protest," has remained in his
position to prevent the administration from "replacing him, possibly with someone who is not even an
actuary," the editorial states. The editorial "wholeheartedly" endorses the legislation recommended by the
actuary groups (New York Times, 4/12).
John E. Gallagher, Vice President of Government Relations 800.642.6065 ext. 6503
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