Last week the U.S. Senate failed to pass a bill, HR 3663, before October 1 which would have extended the DMEPOS accreditation deadline to January 1, 2010. They came through this week by voting it out of the Senate Monday. The bill was presented to President Obama on Wednesday for signing.
This temporary fix will buy Congress some time to fully address the DME accreditation situation through health care reform legislation, which we are optimistic will happen.
A special thanks is owed to Senators Grassley and Harkin and Representative Braley – with whom the IPA Public Affairs staff worked closely – for their support of HR 3663.
As we reported a couple of days ago, the US House and Senate have been in the process of passing an extension for DME accreditation for pharmacies that would push the deadline back to 1/1/10. The House passed the extension, but the Senate HAS NOT passed the extension, despite expectations they would do so yesterday. The Senate is now expected to vote on the extension some time next week, and we are hopeful it will pass.
You are likely wondering what this means for your pharmacy, since we are past the October 1 accreditation deadline without an extension. Here’s what NCPA says the current DMEPOS situation is for pharmacies in the following situations:
Pharmacies that have obtained accreditation and a surety bond: can continue to provide DMEPOS, Medicare Part B drugs and vaccinations.
Pharmacies that have voluntarily terminated from Medicare Part B OR have “stepped down” on their 855S forms (will provide only Part B drugs but NOT DMEPOS) AND the National Supplier Clearinghouse (NSC) has processed your application: will be unable to bill for DMEPOS even if the extension passes next week. (Pharmacies whose applications have been processed will have received a notification letter from the NSC.)
Pharmacies whose “step down” 855s applications HAVE been processed but wish to modify their 855s applications again to be able to dispense DMEPOS in addition to Medicare Part B drugs: you cannot provide DMEPOS even if the extension is passed next week. You will have to wait until your “step-up” application is processed by CMS/NSC to be able to provide DMEPOS again, which could take several weeks.
Pharmacies who have “stepped down” and are waiting to receive their accreditation certificate: billing privileges will exist as of the date on the forthcoming accreditation certificate.
Pharmacies that have voluntarily terminated from Medicare Part B OR have “stepped down” on their 855s form AND you are certain NSC has NOT yet processed your application: can continue to bill for DMEPOS and Part B drugs. NCPA has confirmed from CMS that the NSC will not process any further pharmacy applications requesting to “step down” or voluntarily terminate from the program. Pharmacies can contact the NSC to check on their application status. Also, pharmacies who wish to have their applications processed must write a letter to the NSC asking they complete the processing of your application.
REMEMBER, ANY PHARMACY THAT IS ABLE TO CONTINUE BILLING MEDICARE PART B FOR EITHER DRUGS, VACCINATIONS OR DMEPOS MUST OBTAIN A SURETY BOND.Some flexibility will be given to pharmacies that have not yet purchased their surety bond – days, not weeks. Get your surety bond ASAP!
Hopefully the Senate will pass the deadline extension next week, but if it doesn’t pass then the law as it stands now will be in effect. Accreditation would be required for pharmacies to sell DMEPOS.
We know this is a confusing situation, and the jumbled typeface above doesn’t help the situation, so if you have any questions feel free to get ahold of IPA. Our contact information can be found here.
Both the US House and Senate are expected to bring forth and vote on a proposed 90-day extension for DME accreditation before the deadline this Thursday. If approved, this extension would buy pharmacies more time until the accreditation issue can be formally addressed in health care reform legislation.
Current drafts of health care reform legislation include varying proposals that would grant pharmacies a limited exemption based on either specific DME products or a max percentage of total sales accounted for by DME sales.
Like we mentioned a couple of days ago, the House dropped their “America’s Affordable Health Choices Act of 2009” (HR3200) on Tuesday, July 14. Markups are beginning today, continuing Monday and Tuesday, with a possible committee votes late next week. Rumors have it that the House is on track to pass this legislation before the August recess.
We, as well as the national organizations, have had a chance to scour the bill, and here is a list of the general pharmacy issues it addresses:
AMP “fix”
-Medicaid generic reimbursement is set at 130% of weighted average AMP.
-AMP is redefined to better represent generic drug costs to community pharmacies and not include special pricing/rebates given to PBMs, etc.
DMEPOS
-Accreditation deadline extension provided if application for accreditation has been submitted by 8/1/09.
-There is a limited exemption for diabetes testing supplies, canes and crutches.
-Surety bond exemption is also included.
Medical homes
-A pilot program is established, which is intended to be interdisciplinary. No specific providers named, though.
Pharmacy workforce: loan repayment program
-Pharmacists named as a “Frontline Provider,” which makes them eligible for a loan repayment program (most likely on a competitive basis. This provision was actually included by Rep. Bruce Braley of Iowa.
Check these out for more detail on these provisions:
IPA's Eye On Health Care Reform 