DMEPOS, AMP: APhA monitoring HCR for key fixes
Deadlines pass as pharmacists await Congressional action.
(Update: The Senate passed the below extension
late on October 5 without amendments under unanimous consent. President
Obama signed the bill on October 13, and a
new article has been posted giving with updated guidance for
pharmacies.)
While President Obama today kept the focus on his health care reform
(HCR) efforts by addressing 150 white-coat-clad physicians in the White
House Rose Garden, pharmacists’ eyes are currently
“fixed” on the other end of Pennsylvania Avenue. In addition
to making sure medication therapy management (MTM) provisions stay in
any final HCR bill on Capitol Hill, APhA and other pharmacy groups are
calling for Congressional fixes—some temporary and others
permanent—on requirements for being reimbursed for durable medical
equipment, prosthetics, orthotics, and supplies (DMEPOS) under Medicare
Part B and use of average manufacturer’s price (AMP) formulas for
generic drug product reimbursement in the Medicaid program.
The House of Representatives last week passed a 90-day extension of
deadlines for pharmacies to obtain DMEPOS accreditation so that they can
be reimbursed for these supplies, but the Senate failed to act before
adjourning for the weekend. Unfortunately, the deadline for this
action was late last week, placing many pharmacies in jeopardy for
having their Medicare Part B billing privileges for DMEPOS suspended by
the Centers for Medicare & Medicaid Services (CMS). Over the
weekend, some reports indicated that CMS would delay its
enforcement actions related to the deadline, pending Congressional
action on the temporary delay.
In the meantime, according to discussions with CMS, the agency is
advising that pharmacies, under certain circumstances, can continue to
bill Medicare for DMEPOS supplies. A pharmacy’s status with the
National Supplier Clearinghouse (NSC) will play a role in its next
steps:
- If a pharmacy already obtained accreditation and a surety bond, it
can continue to bill for Medicare Part B covered drugs and DMEPOS.
- If a pharmacy (1) did not seek accreditation, (2) plans to provide
only Part B drugs, (3) already submitted an updated CMS 855S form to
voluntarily remove itself as a DMEPOS supplier, and (4) has already
received confirmation from NSC of their status change, the pharmacy
cannot bill for DMEPOS even if the extension passes.
The pharmacy will need to resubmit an updated CMS 855S
form to opt back in to providing DMEPOS supplies if the extension
passes.
- If, as in the previous scenario, the pharmacy submitted an updated
CMS 855S form but has not received confirmation from NSC of their status
change (e.g., form was submitted last week), it is likely that NSC has
not processed the form. CMS has indicated that such pharmacies can
continue to bill for DMEPOS as long as a surety bond is in place. CMS
will not be enforcing the revocation of a pharmacy’s billing
privileges at this time.
- Pharmacies may wish to contact NSC to find out the status of their
application but should expect delays in getting through to
NSC.
“Medicare accreditation of a pharmacy costs between
$5,000-$7,000 to acquire and renew every three years,” Thomas E.
Menighan, APhA Executive Vice President and CEO wrote in a
letter to three key Senators last week. “Dedicated staff
time takes away from patient care responsibilities and other day-to-day
pharmacy operations.” Menighan also told Montana Democrats Max
Baucus, chair of the Finance Committee, and Jon Tester, member of the
Appropriations Committee, and Sen. Chuck Grassley, Republican of Iowa,
that in many cases “DMEPOS is far less than 10% of a pharmacy's
yearly gross sales” and that “the added burden of
accreditation and the related upfront costs cause some pharmacies,
particularly smaller community pharmacies and safety-net pharmacy
providers under contracts administered by CMS and Health Resources
Service Administration that provide DMEPOS to individuals in underserved
rural and urban areas, to reconsider participation in the Medicare
program.”
Details on DMEPOS were included in the September 23 issue of our
Legislative and Regulatory Update, available to APhA members on
pharmacist.com. Due to anticipated legislative activity, APhA will
provide updated information in its October 7 Legislative and Regulatory
Update.
APhA signed on to a
coalition letter in support of an extension of a moratorium on
AMP cuts that were included in the Deficit Reduction Act of 2008. The
reductions, which were to take effect on September 30, could cause as
many as 20% of all pharmacies to close, the coalition wrote. Provisions
in some of the HCR bills would rewrite generic drug reimbursement laws,
the letter continued, and thus it would be “a mistake for CMS to
implement a law that the Congress clearly wishes to reform.”
Leading the way for much of this year on the DMEPOS and AMP issues
have been the National Community
Pharmacists Association and the National Association of Chain Drug
Stores, two of APhA’s partners in HCR efforts. APhA is working
with these and other organizations to ensure that MTM as well as
permanent DMEPOS and AMP fixes remain in any HCR legislation that ends
up on President Obama’s desk.
Related resources on www.pharmacist.com
Related resources on the Web:
L. Michael Posey, BPharm, (mposey)
Updated October 22, 2009, 5:30 pm EDT
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