DME Accreditation Exemption-
APMA Demands Action

As reported in previous APMA eNews releases, on July 15 Congress exempted physicians and other health care providers from durable medical equipment, prosthetics, orthotics, and supplies (DME) quality standards and accreditation requirements [HR 6331, the Medicare Improvements for Patients and Providers Act (MIPPA)]. This exemption includes podiatric physicians who, since 1967, have been defined as physicians in Title 18 of the Social Security Act, which governs the Medicare program. Accreditation requirements remain in place for retail DME suppliers with a September 30, 2009, compliance deadline.

The Centers for Medicare and Medicaid Services (CMS) has been slow to implement the exemption directives in MIPPA, which are retroactive to June 30, 2008, regarding physicians and other healthcare providers.

MIPPA states that the DME quality standards and accreditation requirements "shall not apply" to such eligible professionals as physicians, physical or occupational therapists, and possibly orthotists and prosthetists, "unless the Secretary [of Health and Human Services] determines that the standards being applied are designed specifically to be applied to such professionals and persons." The Secretary is also authorized to exempt the specified health professionals completely if it is determined that other "licensing, accreditation, or other mandatory quality requirements apply to such professionals and persons with respect to the furnishing of such items and services."

In response, APMA and its partner organizations in the DME coalition that APMA spearheads have over the last six weeks taken numerous steps to ensure that CMS complies with the intent of the law, and this week CMS has begun to respond to the pressure.

• Letter to HHS Secretary: In a July 24 letter to Health and Human Services Secretary Michael O. Leavitt, the DME coalition laid out the differences between their members and commercial suppliers. "The ability of physicians and licensed healthcare professionals to address a patient's condition during the patient visit and to ensure that the patient has received the appropriate DMEPOS with proper instruction on its use and application is integral to the quality and efficiency of patient care," they wrote. "[Y]et, despite numerous letters to and meeting with CMS staff, no changes have been made." Subsequent to the letter, CMS agreed to a meeting with coalition members on August 27.
• Meetings with Congress: APMA and representatives from its partner organizations reached out to key Congressional offices, resulting in a conference call August 18 between CMS and staff of the committees that drafted MIPPA. During that call CMS said that HHS's Office of General Counsel finished its legal review of MIPPA and determined that physicians and other providers do not need to meet the accreditation requirement to receive a DME billing number or otherwise bill for DME. However, it is going to take some time for this information to make its way down to the DME contractors. CMS is going to ask contractors to put a hold on any applications for DME provider numbers so they are not inappropriately rejected. The change will be retroactive to June 30, and CMS indicated it will automatically reprocess any applications that were submitted and rejected after that date.
• Advocacy by HHS' PPAC: Also on August 18, members of the Practicing Physicians Advisory Council (PPAC) approved a recommendation that CMS "immediately halt DMEPOS accreditation requirements for physicians and licensed healthcare professionals and exercise the newly expanded authority to exempt [them] from the quality standards and accreditation requirements based on the licensing, accreditation, and other high-quality requirements physicians and licensed health professionals must currently meet." PPAC is a panel of doctors that advises CMS on regulations and other Medicare issues that affect them. The resolution, offered by council member Jeffrey A. Ross, DPM, was unanimously approved by the other physician members of the council. The language in the recommendation came from a position paper drafted by the coalition, which consists of the American Podiatric Medical Association along with the American Academy of Ophthalmology, American Association of Orthopaedic Surgeons, American Medical Association, American Occupational Therapy Association, American Optometric Association, American Physical Therapy Association, and the Medical Group Management Association.

Watch for the latest information in upcoming editions of APMA's Daily eNews.

CMS Telephone Forum on
DMEPOS Accreditation

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