IMMEDIATE ACTION REQUESTED

URGE MEDICARE TO EXEMPT PHYSICAL THERAPISTS
 FROM NEW DURABLE MEDICAL EQUIPMENT AND O&P RULES

Physical therapists that supply and bill Medicare for durable medical equipment and orthotics for their patients will face severe new rules governing the location of their practice, the amount of liability insurance they must carry – even where they post their business name and office hours, unless Medicare exempts physical therapists from policies intended to apply to commercial DMEPOS suppliers.

APTA is urging physical therapists to write to the Centers for Medicare and Medicaid Services (CMS) and request that physical therapists be exempted from Durable Medical Equipment, Prosthetic, Orthotic and Supplies (DMEPOS) supplier standards related to space sharing, liability insurance per incident, and posting of office hours.

Background:

The Centers for Medicare and Medicaid Services issued a proposed rule January 25, 2008 that would establish new additional standards for suppliers of Durable Medical Equipment, Prosthetic, Orthotic and Supplies (DMEPOS) in the Medicare program.  If a physical therapist in private practice or physician provides and bills Medicare for DMEPOS items, they must enroll in the Medicare program as a DMEPOS supplier and meet the standards established under the Medicare program. 

The proposed new standards would:

• Preclude a DMEPOS supplier from sharing a practice location with another Medicare supplier, including a physician practice, physical therapy practice, or other non-physician practitioner’s practice. Since CMS is aware that physicians and other licensed non-physician practitioners may obtain their own DMEPOS supplier number and furnish DMEPOS from their office, the agency is soliciting comments on whether an exception should be established to this space sharing proposal for physicians and non-physician practitioners.
• Require that a sign with the name and business hours of the supplier be posted and visible at the main entrance of the building – even if the location is a large office building.
• Require that suppliers have a comprehensive liability insurance policy in the amount of at least $300,000 per incident. 

This rule could impact the ability of physical therapists to furnish orthotics, and other DME items to their patients.  To learn more about the rule, read APTA’s summary at http://www.apta.org/AM/Template.cfm?Section=Durable_Medical_Equipment_DME_&Template=/MembersOnly.cfm&ContentID=45895.

APTA urges physical therapists to write a letter to CMS IMMEDIATELY in response to this proposal.  In order for the agency to consider your letter, it must be RECEIVED by CMS by Tuesday, March 25, 2008.

Address and Format for Comments

This is an excellent opportunity for physical therapists to educate the Centers for Medicare and Medicaid Services on the role they play in providing DMEPOS to Medicare beneficiaries.

It is apparent that CMS is exploring ways to ensure that Medicare beneficiaries are receiving quality DMEPOS.  However, the agency needs to ensure quality in a way that does not jeopardize beneficiary access and allows physical therapists to serve their patients.

Individualize your comments.  Your personal experiences and insights will provide the most compelling information.  In addition, CMS is more likely to discount comments that appear to be “form letters.”

Comments can be submitted via mail or electronically.  Instructions for electronic submission can be found at the following link:

http://www.regulations.gov/fdmspublic/component/main?main=DocumentDetail&o=09000064803a2302

Click on the small yellow image next to the words “Add Comments.” Enter in your contact information in the required fields and either (1) copy-and-paste your comments in the text box provided for them or (2) attach them as a Word or PDF document in the same way you would attach a document to an e-mail.

Address to:                  Mr. Kerry N. Weems

                                    Acting Administrator

                                    Centers for Medicare and Medicaid Services

                                    U.S. Department of Health and Human Services

                                    Attention: CMS-6036-P

                                    P.O. Box 8018

                                    Baltimore, MD 21244-8018.

Subject:                       Medicare Program; Establishing Additional Medicare Durable Medical Equipment, Prosthetic, Orthotic, and Supplies (DMEPOS) Supplier Enrollment Safeguards: Proposed Rule.

Identify yourself:          Explain that you are a physical therapist.  Provide brief background on yourself and describe where you practice, how many years you have been in practice, etc.

                                                                                                              OR     

    If your comments are on behalf of an APTA state chapter or component section, provide brief background on yourself, your role in the component, the membership of the component, and any characteristics of their practices.

State the purpose of the letter:  Your heading should read: DMEPOS Supplier Standards.

Explain that you wish to comment on the January 25, 2008 proposed rule on additional standards for DMEPOS suppliers.

TIPS AND TALKING POINTS

Key Point:  Distinguish between the work you do as a physical therapist providing orthotics and other DME items to your patients as an integral part of your plan of care and the work of commercial suppliers who sell DMEPOS.  Urge CMS to revise the proposed regulations to exempt physical therapists from the requirements related to space sharing, posting of office hours, and the $300,000 liability insurance per incident.

Other Points:

• Physical Therapists who provide DMEPOS items as an integral part of patient care to Medicare patients are licensed by the state in which they practice and subject to a wide range of regulatory and other requirements.  In light of these requirements, having to meet the same standards as a supplier company, that is not a licensed health care professional is unnecessary and overly burdensome.
• For physical therapists, Medicare-covered DMEPOS products make up a small proportion of the services they furnish.  Thus it is not feasible to incur the substantial costs to meet the requirements proposed in this rule. 
• Applying these standards to a physical therapist private practice does not make sense.   For example, the proposal to prohibit a DMEPOS supplier from sharing a practice location with another Medicare supplier, “including a physician/physician group or another DMEPOS supplier,” could preclude a physical therapist from providing both orthotics and other services to his/her patients in the same practice location.
• These requirements will pose a serious threat to timely patient access to medically necessary DMEPOS.  Describe situations in which your patients would require an item to be available to them during their visit to assist with mobility or to stabilize an injured body part. 

Tips: Comment letters should reflect the points outlined above, but they should be written in your own words—CMS is most receptive to individualized letters.

Closing: Thank the Administrator for his consideration of your comments. Close with “Sincerely,” and your name.