HCFA: DME upgrade rule likely
The Health Care Financing Administration (HCFA) says it will issue a proposed rule on durable medical equipment upgrades by early 2000. The rule would allow beneficiaries to upgrade durable medical equipment (DME) items that fall outside HCFA’s medical necessity criteria if the beneficiary pays the difference.
The proposal was included in the Balanced Budget Act of 1997 (BBA), but is only now being considered because of the high number of other provisions included in the BBA. Health and Human Services Secretary Donna Shalala blamed the high volume of changes required by the BBA required the agency to prioritize its implementation schedule.
In general, DME suppliers favor the provision, but government officials want to ensure that any new regulation would protect beneficiaries from being bilked. HCFA wants to guard against suppliers misrepresenting the need for upgraded items.
While consumer advocates are expected to protest any upgrade provision, DME industry leaders argue the provision is needed to supply beneficiaries with equipment currently not covered by Medicare. For example, a patient who cannot propel a manual wheelchair and would benefit from a powered chair would currently be eligible for a basic unit. Under the new provision, HCFA would have to reconsider the basic unit in favor of a higher-end chair.
"We think there are business opportunities here," says Dave Willimas, director of government affairs for Elyria, OH-based Invacare. "More importantly, it gives people the opportunity to look at both what is available and what is medically necessary to make intelligent consumer choices."
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