AMARILLO, TX – With the exception of the 1917 influenza pandemic, what the country is experiencing today is unprecedented. It is a fair statement that the United States was not prepared for COVID-19.
All of us—citizens and health care providers alike—are scrambling to exert control over the coronavirus. The most valuable real estate in the country right now are hospital beds. This is where the DME industry plays a critical part. By providing equipment and services to patients in the home, DME suppliers are keeping patients out of the hospitals, thereby freeing up beds for coronavirus patients.
Recognizing the important part that DME suppliers are playing in combatting this virus during the pandemic, CMS has relaxed coverage, documentation, testing, and other requirements to allow DME suppliers to provide immediate care to respiratory patients. It is critical that DME suppliers (i) operate under the relaxed rules for the sole purpose of being a good citizen and confronting the coronavirus and (ii) not attempt to use the relaxed rules simply to make money.
The DME industry has exerted a great deal of effort over the past seven to ten years to build up its credibility with CMS and Capitol Hill. If CMS and Capitol Hill perceive that some DME suppliers are trying to take advantage of the COVID-19 crisis for financial gain, then such credibility will be tarnished. With all of this in mind, AAHomecare published a statement entitled “Providers Urged to Use Best Judgment in Following New CMS Guidance.” Here is the complete statement:
Providers Urged to Use Best Judgment in Following New CMS Guidance
Over the last three weeks, CMS has granted the HME community a significant measure of relief in relaxing the coverage, documentation, testing, and other requirements to allow the HME community to effectively respond to the COVID-19 outbreak. In consultation with Association leadership and our legal counsel, AAHomecare has developed this statement urging suppliers to exercise sound judgment in applying the new guidance from CMS.
AAHomecare Policy Statement on COVID-19 and the Role of HME Supplier
The COVID-19 pandemic has shown a spotlight on the importance that HME providers play in delivering care to patients in their homes. By allowing patients to remain in their homes, HME providers are freeing up hospital beds for COVID-19 patients and other patients with similarly serious health problems. In response to the unprecedented need to keep patients at home and avoid hospital overflow issues, government agencies and other payors are relaxing many of the requirements normally in place to ensure that payors only pay for HME items and services that are appropriate for the patient’s conditions.
Despite the relaxation of many of the coverage, documentation, testing, and other requirements, it is important for the HME provider community to be responsible and credible components of the health care system. The goals of the rule relaxation are (i) to ensure that patients with real medical needs can access the appropriate respiratory medical equipment in their homes, (ii) to minimize the spread of COVID-19, and (iii) to free up hospital beds to those who truly need them. Sensational and aggressive marketing tactics may be fraudulent and abusive. They are certainly unethical and inappropriate and will significantly damage the progress the HME community has made with policymakers in recent years.
AAHomecare suggests that even though the coverage and other Medicare criteria have been relaxed, HME providers should exercise their best judgment in following the new guidance. CMS has made these changes to (i) help the HME community provide exceptional care in challenging conditions, (ii) help alleviate the extraordinary burden many hospitals are facing, and (iii) reduce the risk of exposure to the COVID-19 virus for both patients and HME professionals. HME providers should continue to ensure that their patient care and business practices during this pandemic adhere to both the (i) “letter of the law” under the relaxed regulations and (ii) the “spirit of the law” (i.e., the reasons this regulatory relief has been granted). Even though Medicare and other payors have relaxed certain requirements, the federal and state laws prohibiting kickbacks, inducements, false claims, and other fraudulent and abusive behavior remain intact. HME providers should ensure that their communications with referral sources and patients do not run afoul of these laws. It is critical that HME providers not use the relaxed requirements to engage in fraudulent and/or unethical acts designed solely to generate revenue. We are all in this together, and there is no room for any type of questionable behavior. AAHomecare urges the HME community to police itself and report any suspect behavior to the National Center for Disaster Fraud Hotline: 866-720-5721 or [email protected]. We urge providers to contact their legal counsel with specific questions.
We are all in this together. It is important that we show legislators, regulators, physicians, other health care providers, and patients that the DME industry is a team player and is dedicated to do its part to confront this crisis.
AAHOMECARE’S EDUCATIONAL WEBINAR
COVID-19: Practical Legal Advice on How to Navigate These Strange Waters
Presented by: Jeffrey S. Baird, Esq., Brown & Fortunato, P.C. & Bradley W. Howard, Esq., Brown & Fortunato, P.C.
Tuesday, April 14, 2020
1:30-2:30 p.m. CENTRAL TIME
It is an understatement to say that what the country is experiencing is unprecedented—there is no playbook on how to respond. The law is frantically trying to catch up with events unfolding on the ground. This webinar will discuss practical legal steps that DME suppliers should take to make it through this bizarre time. Specific topics to be discussed include: (i) what to do if an owner or key employee exhibits COVID-19 symptoms; (ii) how to handle a patient who exhibits symptoms or who may have a positive diagnosis; (iii) Emergency Paid Sick Leave Act; (iv) Emergency Family and Medical Leave Expansion Act; (v) recent Department of Labor regulations; (vi) new telehealth guidelines; (vii) steps to take when business declines; and (vii) infection control procedures.
Register for COVID-19: Practical Legal Advice on How to Navigate These Strange Waters on Tuesday, April 14, 2020, 1:30-2:30 p.m. CT, with Jeffrey S. Baird, Esq., and Bradley W. Howard, Esq., of Brown & Fortunato, PC.
This webinar is free for attendees.
Jeffrey S. Baird, JD, is chairman of the Health Care Group at Brown & Fortunato, PC, a law firm with a national health care practice based in Texas. He represents pharmacies, infusion companies, HME companies and other health care providers throughout the United States. Mr. Baird is Board Certified in Health Law by the Texas Board of Legal Specialization, and can be reached at (806) 345-6320 or [email protected].
