But you don't have to fight the battle alone. Contact information for all state associations, and for the American Association for Homecare, is included at the end of this newsletter.

From Around the Country
Alabama--The Internet is having an effect in Alabama. Blue Cross, the state's predominant health care payer, is questioning why CPAPs can be purchased so cheaply online. The Alabama Durable Medical Equipment Association is meeting with the giant carrier "to help them understand the product category," said Executive Director Mike Hamilton. That includes explaining that good outcomes, which depend on patient compliance, require a lot of hands-on provider involvement. "One of our members brought in a board-certified sleep specialist with a hospital-based sleep lab to explain that ... more than half of the price of putting a CPAP out successfully is in the services provided," Hamilton said. He noted the discussion has now turned from "Why shouldn't we buy this product on the Internet?" to "How can we make this product category the most cost-effective that it can be for our subscribers?" Standards to eliminate "rip-off artists that gouge the system with shoddy products and no service" may also come into play, he said.

California--The California Association of Medical Product Suppliers remains in settlement talks with the state about a lawsuit the group filed in June 2004 over rate reductions in Medi-Cal, the state's Medicaid program. Effective since January of last year, Medi-Cal pays no more than 80 percent of the Medicare allowable for most listed DME. When then-governor Gray Davis passed the cuts in 2003, "nobody determined that 80 percent of the Medicare [allowable] was reasonable," said CAMPS Executive Director Bob Achermann, who added that "we're very close to a resolution on the lawsuit." The association is also supporting a bill that would require custom rehab providers who bill Medicaid to have certified personnel on staff, either credentialed with the Rehabilitation Engineering & Assistive Technology Society of North America (RESNA), or registered with the National Registry of Rehabilitation Technology Suppliers (NRRTS). The bill has "strong support," Achermann said, and is expected to pass.

Florida--Florida HMEs continue to have their work cut out for them in billing, because a large part of the state's population--"snowbirds," or patients who spend only part of the year in the state--can create Medicare billing nightmares. But the most notable issue facing providers in the past several years has been competitive bidding. In 2002, the Florida Association of Medical Equipment Services won a $200,000 lawsuit that put a halt to a DME bidding proposal by the state Medicaid agency. In 2003, competitive bidding came up again in the budget language, though the agency never implemented it. This year, providers lobbied lawmakers to remove the competitive bidding language from the budget once and for all--and replaced it with language giving the state health agency the authority to require all Medicaid DME providers to be accredited. Earlier this month, a bill mandating accreditation for Medicaid DME suppliers by January of 2006 died in committee. But, said Brian Seeley, association president and president of Ormond Beach, Fla.-based Seeley Medical, "We are expecting this issue to come up again, and FAMES will certainly be prepared to address it."

Hawaii--As if doing business in Hawaii wasn't expensive enough, providers are now facing the nation's most severe reimbursement cuts for oxygen. The 2005 rates CMS issued in March called for a 20 percent cut on stationary oxygen and 29 percent for portable systems. "They were terrible. [Now we're working on] how we can adjust accordingly," said Rose Ann Poyzer, vice president of the Healthcare Association of Hawaii, Home Care & Hospice Division. "It's a serious issue." Providers in the state face a number of additional costs including mandatory employer-sponsored health care coverage, property values increasing by more than 20 percent each year, a state gross excise tax of 4 percent on prescribed services--and a freight factor that can add close to 10 percent to the cost of goods because they must be shipped in by boat or plane.

Indiana--Persistence paid off for the Association of Indiana Home Medical Equipment Services, which helped to pass legislation this year requiring DME suppliers to be licensed. "We've tried for three years to get licensure and couldn't get a hearing in an oversight committee," said Jean Macdonald, AIHMES' director of public policy. But this session, during a hearing about fraud, a member of the state Attorney General's office mentioned that HME companies weren't licensed, she said. "Suddenly the light went on. [The bill] sailed through without any problems." The details have yet to be pounded out, according to Macdonald, so the new rule is not likely to take effect for another year.

Louisiana--The Medical Equipment Suppliers Association is helping Louisiana providers brace for a change that will remove Medicaid coverage for DME used in nursing homes. According to a notice of intent issued by the Louisiana Department of Health & Hospitals, items that are currently paid through DME providers--including custom wheelchairs, ventilators, oxygen and oral nutrition--will be part of the per-diem rate in nursing homes. The change is scheduled to take effect July 1. MESA has formed committees and held meetings on the subject, but unless CMS or the Louisiana Department of Health & Hospitals make a change to the proposal, it appears to be a done deal, said Wanda Ellis, a member of the MESA board of directors and branch manager at Apnix in Baton Rouge. "The impact on the nursing home will be astounding," Ellis says. "The impact on DME providers will be worse. You're going to have a lot of providers who are going to go out of business."

Massachusetts--For the past few months, providers in Massachusetts have been receiving more denials than usual when submitting Medicaid claims with modifiers. "For some of our members, it's really caused a financial hardship," said Karyn Estrella, executive director of the New England Medical Equipment Dealers Association. "The companies that have been hardest hit are custom-rehab providers." A NEMED survey indicated Massachusetts members are off 20 to 50 percent on accounts receivable because of the problem. New Medicaid regulations adopted in July last year are the culprit, Estrella said. "We are continuing to work with the state to get these issues resolved."

Missouri--Earlier this month, Missouri was dealt a huge blow when Gov. Matt Blunt signed legislation that would eliminate the state requirement to fund Medicaid coverage for adult DME. The 2006 state budget will fund some DME, but many items, including wheelchair accessories and batteries, hospital beds and orthotics, will not be covered. The Midwest Association for Medical Equipment Services is currently investigating "to see if the state has the authority to do what they did" and educate lawmakers on the issue, said Executive Director Rose Schafhauser. "There is no rationale to pay for an electric wheelchair but not a battery," said Schafhauser. "What good is it going to do? You're going to increase the amount [the state] will have to pay because [people] will be stuck in a hospital or nursing home."

Nevada--The Nevada Association of Medical Product Suppliers has been working since January to pass a bill that would eliminate sales tax on all DME. "We've got a lot of support," said NAMPS President Richard Pozesky. "I just want to make it so nobody has to pay sales tax on their medical equipment." Currently, private individuals and insurance companies are charged sales tax--typically 7 or 7.5 percent, depending on the county--on most DME, while government payers are exempt. "It's substantial if you're buying a power wheelchair," said Pozesky, who added that consumers could save $750 on such a purchase.

New York--Since the New York State Department of Health closed its Medicaid Manhattan office and transferred the work to a central office in Albany Nov. 1, many DME prior approval requests have been drastically delayed. Alan Landauer, president of Landauer Metropolitan in Mount Vernon, N.Y., and the newly elected president of the New York Medical Equipment Providers Association, said prior approvals that used to take six weeks are now taking six months to a year. "The interpretation of the New York [Medicaid] rules is different in Albany than it [was in] New York City," he said. NYMEP has formed a committee to work with United Cerebral Palsy of New York City and other consumer advocacy organizations "to be able to understand the problems and solve them ... I think it's important the Department of Health is cooperating, working hard with NYMEP in solving [the problems]," Landauer continued.

North Carolina--The North Carolina Respiratory Care Board is in the process of drafting a rule change to allow only RCPs or other appropriately licensed individuals to set up CPAP/bi-level units and fit sleep therapy masks. "Many HME providers feel this goes against the NCRCB statute that exempts support activities such as the set-up and demonstration of devices," said Beth Bowen, executive director of the North Carolina Association of Medical Equipment Services, who added that the rule change must go through the normal process set by the state. That includes a public hearing where "HME providers plan on making their issues known," she said. Bowen also noted that North Carolina is celebrating is 10th year of licensure for providers. "It became a mission of NCAMES in 1994 to push for state licensure, and after extensive grassroots lobbying by our members ... the law became effective in July of 1995. North Carolina became the first state in the U.S. to have licensure, and now many more have followed. These last 10 years, with the North Carolina Board of Pharmacy's help, have seen tighter regulations for those providing home medical equipment--including out-of-state providers--to our citizens. The goal was not only to provide a level playing field for all providers but to curb fraud and abuse by having a regulatory arm with which to secure that quality service continues to [those] who choose home care."

Ohio--The Ohio Association of Medical Equipment Services has a busy day today. At 5 p.m. inside the state Capitol atrium in Columbus, the association has organized a kind of HME show-and-tell for state officials called "Bringing Care Home for Ohioans." Staffed with more than 40 association volunteers, the show will highlight different sectors of the industry--from rehab to respiratory to billing and reimbursement--featuring products, clinicians and people who actually use the equipment. Even Ms. Wheelchair Ohio is scheduled to attend. The event has "captured a lot of momentum" in recent weeks, said OAMES Executive Director Kam Yuricich. "We're making a bold statement that this industry is positioned to do a lot of what legislators are trying to do: bring costs down for the Medicaid program." At least 40 legislators were expected to attend, "but ... we'll probably get a lot more," she said, explaining that as regulators and legislators leave their offices for the day, they'll pass by the exhibits. "It's about bringing home care to the forefront for [the state's] decision-makers," Yuricich continued. "If you haven't used the services of this industry, you're probably not familiar with it at all."

Pennsylvania--Killing a proposal that would put caps on DME expenditures for Medicaid patients has been at the top of the agenda for the Pennsylvania Association of Medical Suppliers. Gov. Ed Rendell's proposal would allow $5,000 per adult per year. Those who would be hit the hardest are chronically ill trauma patients without insurance, according to PAMS Executive Director David Fiorini. "How are they going to be able to deny someone in a traumatic situation a power wheelchair or oxygen if [the patient] exhausts that [$5,000] in nine months?" he questioned. Some providers have said they may pull out of the Medicaid program altogether if they are not reimbursed, while others say they would try to come up with other ways to get the funds, Fiorini added. For now, PAMS members are busy contacting state legislators about the issue.

South Carolina--The South Carolina Medical Equipment Services Association hopes to bring some relief to providers by pushing a bill to eliminate state sales tax for DME. Currently, HME providers are prohibited from passing on the cost of the 5 percent tax. "It's very unfair," said SCMESA Executive Director Bobby Horton. The proposed bill calls for gradually phasing out the tax, reducing it by 1 percent each year. "This will be a biggie," said Horton, who expects the bill to receive more attention in the next legislative session. "It puts 5 percent back into the providers' pockets."

Tennessee--A heated battle over Tennessee's plans to cut 323,000 adults from its Medicaid rolls has made its way into the courts, and it remains to be seen whether the state will be allowed to proceed. Shortly after Gov. Phil Bredesen's plan was approved earlier this year, several lawsuits were filed against the state. The plan has been back and forth in the court system ever since. Its fate now rests with the U.S. Court of Appeals for the 6th Circuit, which said it expects to issue a decision before June 1. However the scenario plays out, according to Gayla Sasser, executive director of the Tennessee Association for Homecare, it will just be a shifting of costs to others such as the state's health care providers, from doctors and hospitals to home care. "What we will see happening is the [health care] provider community will end up paying bills for those folks," she said. For now, the organization is concentrating on communicating with the governor's office on the issue, she said. "I think it's a wait-and-see game."

Washington--In April, when the Pacific Association of Medical Equipment Services saw Washington State's budget pass with $1.7 million in Medicaid cuts for HME in 2006, Bruce Thompson, the group's Medicaid committee chairman, helped set up meetings with the Washington Department of Social and Health Services to "understand what these cuts mean and where they're looking to apply them. Our Medicaid system, like so many other states, is being forced into cutbacks," said Thompson, who is also general manager for Aero Medical in Aberdeen. The current budget leaves it up to DSHS to decide which product coverage will go on the chopping block, he explained, adding that for 2007, the budget calls for even bigger cuts totaling $7.6 million. At the same time, the association is negotiating for appropriate Medicaid payments for incontinence supplies, working to "rewrite the Washington Administrative Code to develop better pricing methodology and clearer guidelines," Thompson said. For such supplies, the association has proposed rates at 45 percent above costs and is waiting for a response from the state health department.

State Contact Information
Many state associations have scheduled annual meetings for this summer, and the American Association for Homecare will hold its Leadership Conference June 7-10 in Washington, D.C. For more information on upcoming meetings and current national or state issues that affect your business, contact:

American Association for Homecare
Phone: (703) 836-6263
Web site: www.aahomecare.org
Kay Cox, president and CEO

Alabama Durable Medical Equipment Association (ADMEA)
Phone: (866) 808-2022
Web site: www.admea.net
Mike Hamilton, executive director

Arizona Medical Equipment Suppliers Association (AZMESA)
Phone: (651) 439-2944
Web site: www.azmesa.org
Rose Schafhauser, executive director

Big Sky Association for Medical Equipment Services (Big Sky AMES)
(Idaho, Montana, Wyoming)
Phone: (406) 676-4441, ext. 321
Web site: www.bigskyames.com
Maggie Roddam, secretary-treasurer

California Association of Medical Product Suppliers (CAMPS)
Phone: (916) 443-2115
Web site: www.campsone.org
Robert Achermann, executive director

Colorado Association of Medical Equipment Services (CAMES)
Phone: (303) 755-1294
Web site: www.cames.org
Michelle Clopton-Davis, administrative contact

Florida Association of Medical Equipment Services (FAMES)
Phone: (407) 895-5573
Web site: www.famesonline.org
Heather E. Allan, executive director

Georgia Association of Medical Equipment Services (GAMES)
Phone: (866) 808-2022
Web site: www.gameshme.org
Mike Hamilton, executive director

Healthcare Association of Hawaii (HAH)
Phone: (808) 521-8961
Web site: www.hahc.org
Rose Ann Poyzer, vice president, Home Care & Hospice Division

Illinois Association for Medical Equipment Services (IAMES)
Phone: (630) 369-7782
Web site: www.iames.org
Adonna Jerman, executive director

Association of Indiana Home Medical Equipment Services (AIHMES)
Phone: (317) 844-6643
Web site: www.aihmes.org
Todd Stallings, executive director

Jersey Association of Medical Equipment Services (JAMES)
www.jamesofnj.org
Terri Maggio, executive director

Kentucky Medical Equipment Suppliers Association (KYMESA)
Phone: (502) 223-5322
Web site: www.kymesa.org
John Underwood, executive director

Maryland-National Capital Homecare Association (MNCHA)
Phone: (301) 473-9801
Web site: www.mncha.org
Eric Failing, executive director

Medical Equipment Suppliers Association (MESA)
(Arkansas, Louisiana, Oklahoma, Texas)
Phone: (800) 722-2310
Web site: www.mesanet.org
Elizabeth Moran, executive vice president

Michigan Home Health Association (MHHA)
Phone: (517) 349-8089
Web site: www.mhha.org
Harvey Zuckerberg, executive director

Midwest Association for Medical Equipment Services (MAMES)
(Iowa, Kansas, Minnesota, Missouri, Nebraska, North Dakota and South Dakota)
Phone: (651) 351-5395
Web site: www.mames.com
Rose Schafhauser, executive director

Mississippi Association of Medical Equipment Suppliers (MAMES)
Phone: (601) 932-1001
Danyelle "Dee" Carroll, president

Nevada Association of Medical Product Suppliers (NAMPS)
Phone: (702) 294-6680
Web site: www.namps.org
Richard J. Pozesky, president

New England Medical Equipment Dealers Association (NEMED)
(Connecticut, Maine, Massachusetts, New Hampshire, Rhode Island, Vermont)
Phone: (508) 993-0700
Web site: www.nemed.org
Karyn Estrella, executive director

New York State Medical Equipment Providers Association (NYMEP)
Phone: (518) 436-9637
Web site: www.nymep.org
Carol Napierski, executive director

North Carolina Association of Medical Equipment Services (NCAMES)
Phone: (919) 387-1221
Web site: www.ncames.org
Beth Bowen, executive director

Ohio Association of Medical Equipment Services (OAMES)
Phone: (614) 876-2424
Web site: www.oames.org
Kam Yuricich, executive director

Pacific Association for Medical Equipment Services (PAMES)
(Oregon and Washington)
Phone: (503) 253-9691
Web site: www.pames.org
Michael Fisher, executive director

Pennsylvania Association of Medical Suppliers (PAMS)
Phone: (717) 795-9684
Web site: www.pamsonline.org
David Fiorini, executive director

South Carolina Medical Equipment Services Association (SCMESA)
Phone: (803) 731-9216
Web site: www.scmesa.com
Bobby E. Horton, executive director

Tennessee Association for Home Care (TAHC)
Phone: (615) 885-3399
Web site: www.tahc-net.org
Gayla M. Sasser, executive director

Greater Texas Rehab Providers' Council (TXRPC)
Phone: (713) 686-9950
Web site: www.txrpc.org
Ron Kieschnik, president

Virginia Association of Durable Medical Equipment Companies (VADMEC)
Phone: (804) 285-4431
Web site: www.vadmec.org
Rebecca Snead, executive director

West Virginia Medical Equipment Suppliers Association (WVMESA)
Phone: (304) 344-5320
Richard Stevens, executive director

Wisconsin Association of Medical Equipment Services (WAMES)
Phone: (715) 366-7500
Web site: www.wames.org
Ann Barrett, executive director

Visit this newsletter's sponsor at www.medforcetech.com.