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CURRENT
EVENTS
DME SITUATION SYNOPSIS
"2003 The Medicare Modernization Act of
2003 included Accreditation and Competitive Bidding requirements
for "anyone wishing to bill Medicare Part B". This
means that of the 107,000 Medicare Part B providers all would
have to become accredited by 2007 per this statute.
Industry #'s on providers state that about 6-8,000 of all providers
are accredited leaving 99-100,000 providers at risk without accreditation.
Pharmacies are included in both numbers although the % accredited
is even lower than 6-7%
Nothing much
was said until September 2005
2005
September - The committee that advises Medicare suggested that
they tie accreditation to Competitive Bidding markets and
phase it in over 2007-2009. Everyone relaxed thinking they
caught a breather.
2006
April - Medicare issued a 203 page report detailing their latest
"rules". This included non-specific rejection
of the committee's 9/05 recommendation and reiteration that EVERYONE
wanting to bill Medicare Part B would need to be Accredited in
2007
Medicare has not given a specific date in 2007 for Accreditation
to kick in. Speculation is that it WON'T be 1/1/07 but
it could be anytime. To change it from 2007 would require
the law to be amended or some other Act of Congress and there
isn't anything in the works to do this. Many groups including
NCPA are fighting on our behalf to exempt small DME suppliers,
but in the mean time Keystone is working with two different organizations
to help our stores prepare for accreditation. Just getting
ready for accreditation will cost $2500 and then the accrediting
groups (JCAHO, ACHC, and CHAP) charge between $3500 & $10,000
based on the size of the company (how many home/rental patients).
If you fail the accrediting inspection, you must reapply &
pay the above fees again so we are looking closely at companies
that will assure that you are properly prepared.
We are also
looking into forming a network for competitive bidding through
the Federation of Pharmacy Networks.
More information to follow..
Pennsylvania
Immunization Update:
The
State Board of Pharmacy now has the application for the authorization
to provide immunizations available on their website http://www.dos.state.pa.us
Three important things to note:
1 You must first renew your Pennsylvania Pharmacist license through
2008
2 You complete page 1 of the application and mail to the State
Board with your copy of your current CPR certificate & $30
fee (CPR classes available at PPA conference in August)
3 You complete top of page 2 & send it to the course provider
for your immunization Course, who must complete it & return
it to State Board (Also available from PPA)
PACE
With the signing of SB1188, the PACE/PACENET program has begun
their efforts to combine program benefits with Medicare Part
D. Letters to the PACE/PACENET cardholders were mailed
beginning Wednesday, July 19, 2006. Recognizing that PACE/PACENET
cardholders may present these documents to PACE pharmacists as
early this Thursday, we are providing pharmacy organizations
with this information by e-mail to enable them to inform their
members and/or employees. The Program also intends to include
sample letters with the PACE Remittance Advice of this Friday,
July 21.
We are hopeful that the documents will assist you in answering
any questions you may receive from clients or constituents.
But, there are three main points that we would like you to convey:
1) Individuals are NOT losing their PACE/PACENET benefits nor
are they diminishing in any way,
2) The program would like the individual to accept the Part D
plan it selected for the individual, unless they are already
enrolled in another Part D plan.
3) Individuals should call the PACE toll-free number at 1-800-225-7223
if you cannot answer their questions from the guidance provided
on the documents.
Thank you for your assistance.
The PACE Program
PACE will save about $100 million dollars per year and promises
to use these savings to expand the benefits. Of course
Pharmacy will see lower reimbursements from the Part D plans
so we have suggested that they use some of their savings to increase
Pharmacy Reimbursements No response heard or expected.
PaceNet patients will no longer have a $40 deductible per month;
it will be replaced by them paying for their Medicare Part D
plan which is $10-$15 lower per month. Rx's not covered
by their Part D Plan, will be covered by PACE or PaceNet.
We are still recommending the CCRX Plan which does not offer
a mail-order option and has better reimbursements, as well as
a MTM program in place. CCRX is one the 6 approved plans
from PACE.
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