The Centers for Medicare & Medicaid Services (CMS) has suggested significant changes to its accreditation requirements for durable medical equipment, prosthetics, orthotics and supplies (DMEPOS) suppliers — as well as big changes for the accreditation organizations themselves.
CMS listed the changes it wants to see in the home health proposed rule published July 2 in the Federal Register. The proposed rule also contains Medicare competitive bidding program changes that American Association for Homecare (AAHomecare) CEO/President Tom Ryan said are “an asteroid heading straight to planet DME [durable medical equipment].”
In AAHomecare’s Aug. 6 webinar on the proposed rule, Cara Bachenheimer, AAHomecare’s general counsel, Brown & Fortunato, told attendees, “There’s a significant change to the accreditation requirements. From a supplier perspective, one of the proposals is to change the mandatory surveys from every three years to every year.”
That would mean every location of a provider’s DMEPOS business would need to be surveyed every year.
“As part of its proposed rule, CMS is always required to do a regulatory impact statement, which talks about the costs that are imposed on the regulated industry,” Bachenheimer added. “And they are estimating that between all eight accreditation organizations, they would have to hire only 24, collectively, additional employees to actually administer those surveys.”
That estimated increase already sounds small, since accreditation organizations would being required to triple the number of surveys they perform annually. But Bachenheimer added that the new estimated headcount does not include the non-employees typically contracted to administer those surveys. “They don’t count the contractors as part of their regulatory impact statement,” she said. “I know the accreditation organizations are all working on comments, as well, and have had a lot of conversations about the additional impositions on the accreditation organizations.”
CMS is accepting public comments on the proposed rule through the end of the business day, Eastern time, on Aug. 29.
Accrediting organizations as law enforcement
CMS is also proposing to change the very nature of the work done by accrediting organizations, Bachenheimer said.
“The accreditation organizations are enforcing the Medicare quality standards,” she said. “What CMS appears to want is to turn them into law enforcement officials and to look at fraud, waste and abuse, and potential over-utilization, which is a completely different role than the accreditation organizations have traditionally had.”
Mina Uehara, AAHomecare’s senior director of regulatory affairs, added, “I do want to highlight that CMS also asks whether accreditation organizations should conduct surveys in between those initial surveys and the re-accreditations. [CMS wants] to use this as a fraud tool, as well — so, unannounced surveys in between those one-year-mark surveys.”
Ryan said that the proposed rule estimated that changing the policy to include annual accreditation could cost suppliers an additional $128 million.
“And that’s probably a low estimate, we know,” Bachenheimer said.
“It’s very difficult to do, considering how much it takes for a supplier to prepare for a survey,” Uehara said. “Not only that, but also for the accreditation organization, as well.”
