The New Jersey State Board of Respiratory Care issued proposal number PRN 2010-103 on July 6, 2010.

The full summary of the proposed changes appear on the New Jersey Division of Consumer Affairs webpage.  

Public comments on the proposed changes are being accepted until September 4, 2010. 

Public comments may be submitted electronically through the New Jersey Division of Consumer Affairs webpage, or in writing.

Home medical equipment could become harder to get
Saturday, July 31, 2010
SPECIAL TO THE TIMES

In recent years, policymakers in Washington, D.C., have been trying to cut health-care costs, especially in Medicare, the federal health-care program or senior citizens and people with disabilities. The spending cuts and reforms have left many of New Jersey's 1.3 million Medicare beneficiaries wondering: "What does this mean for me?"

For many of New Jersey's Medicare beneficiaries and their families, what it will likely mean is that it will be harder to get access to the home medical equipment and services they need to stay healthy and independent in their own homes -- and out of a nursing home or hospital.

Even though spending on home medical equipment is less than 2 percent of the total Medicare budget, and even though reimbursement rates have been cut deeply and disproportionately over the years, Washington bureaucrats are attempting to squeeze even more out of this small, cost-effective sector.

One of the most troubling and misleading schemes scheduled to take effect soon is the Medicare "competitive" bidding program for home medical equipment and services, which includes oxygen therapy, wheelchairs, hospital beds and other durable medical equipment used at home.

This bidding program is designed to eliminate most of the home medical
equipment providers in the U.S., even if they bid low to provide home
medical equipment and services. That became clear when the program was first implemented in 2008, in 10 areas around the U.S. Congress halted the program due to numerous problems and flaws, such as Medicare contracts awarded to unlicensed home medical providers. However, in re-implementing the bidding system, the Medicare program did not make the changes needed to protect homecare patients and providers.

As it stands, the Medicare bidding program encourages "suicide bidding."
Because Medicare is the primary payer for senior citizens and people with disabilities who use home medical equipment, Medicare can use economic coercion to force home care providers to submit to unsustainably low bids needed to "win" one of the few contracts offered. In the end, this Medicare bidding scheme will actually discourage competition in the home medical equipment and services sector, reduce access to care for patients and put hundreds of New Jersey providers out of business. The bidding process is complete in nine metropolitan statistical areas in the U.S., and that same process begins in 2011 in three regions that cover 80 percent of New Jersey.

The sad irony is that this misguided program will actually increase costs
over the long run. With fewer available providers of home care equipment and services, many patients will be forced into far more expensive post-acute care alternatives, such as hospitals or nursing homes, which will simply shift costs to other parts of the health-care system.

When it comes to caring for patients in the home, there is no need for a
tradeoff between quality and affordable care. Home care is both
cost-effective and the preferred method of care by senior citizens and
patients because it provides them with independence and allows the
opportunity to be close to family and friends. The more patients rely on
quality health-care equipment and services at home, the less the U.S. will have to spend on longer hospital stays, emergency room visits and nursing home admissions.

Providers of home medical equipment and services across New Jersey are proposing a more fiscally responsible alternative to the "competitive"
bidding scheme. The Jersey Association of Medical Equipment Services and hundreds of local providers of home care equipment and services proudly support H.R. 3790, a bipartisan bill in Congress that would preserve access to home care and provide a cost-effective alternative to the misguided Medicare "competitive" bidding program for durable medical equipment. So far, the bill has 252 cosponsors in the U.S. House of Representatives, with broad bipartisan support. More than half of the New Jersey delegation in the U.S. House of Representatives are co-sponsoring the bill.

H.R. 3790 would replace the troubled bidding program while ensuring that the projected cost savings of the program are met through a series of payment reductions for home medical equipment providers across the country. This important bipartisan bill will preserve high-quality home care services and equipment for New Jersey patients and prevent the needless closing of businesses across New Jersey during an already difficult economy.

The New Jersey Medicare population should be gravely concerned about the bidding scheme, which will delay access to necessary medical equipment, reduce the quality of the medical equipment provided and place additional economic strain on the state's small business community.

Wendy Russalesi is executive director of the Jersey Association of Medical Equipment Services.

The Times of Trenton, July 31, 2010

CONTACTS:

Wendy Russalesi, 732-503-5665, Jersey Assn. of Medical Equipment Services, wrussalesi@jamesofnj.org; 

Michael Reinemer, 703-535-1881, American Assn. for Homecare, michaelr@aahomecare.org. 

New Jersey’s Seniors Will Pay Steep Price for Medicare’s
“Competitive” Bidding Program for Home Medical Equipment

JACKSON, NJ, July 27, 2010 ------ Seniors and people with disabilities who rely on home medical equipment and services in New Jersey will pay a steep price under Medicare’s controversial and mislabeled “competitive” bidding program for durable medical equipment.  With the recent passage of the health reform bill, this program is now slated to encompass 80 percent of New Jersey during the second round of bidding.

The U.S. Department of Health and Human Services announced recently that bidding in nine of the country’s largest metropolitan areas could save Medicare as much as $17 billion over 10 years for home medical equipment and services. But those alleged savings are the result of “suicide bids” from providers in an ill-advised race to the bottom that will put thousands of homecare providers out of business and reduce patients’ access to care. Recognizing that the program is bad healthcare policy, a bipartisan group of 254 lawmakers in the House of Representatives support legislation that would repeal the bidding program but preserve the projected cost savings for Medicare.

“New Jersey’s Medicare population should be gravely concerned about this bidding program,” says Wendy Russalesi, executive director of the Jersey Association of Medical Equipment Services (JAMES), which represents providers of home medical equipment in the state. “This program will do nothing more than delay access to necessary medical equipment, reduce the quality of the medical equipment provided, and place additional economic strain on the small business community of New Jersey.”

The Medicare bidding program uses economic coercion to force homecare providers to submit unsustainable bids necessary to win a contract. Because Medicare is the largest third-party purchaser of home medical care, its market power effectively coerces providers to bid at unsustainable reimbursement rates to ensure the opportunity to continue serving Medicare beneficiaries. Ultimately, the below-market rates achieved through this bidding program will force thousands of businesses to close, reducing competition in the long term and reducing seniors’ access to care and choice of providers.

Congress delayed the implementation of this bidding program in 2008 to allow for needed changes, and the home medical equipment sector paid for that delay by taking a 9.5 percent nationwide reimbursement cut to pay for the projected savings from the initial round of the program. However, the Centers for Medicare and Medicaid Services (CMS) ignored congressional intent, did not address the flaws that precipitated the delay two years ago, and is now recklessly charging forward with the program in nine of the 10 largest metropolitan statistical areas in the U.S.  An additional 91 areas will be subjected to the bidding process next year.

“CMS is working on the flawed concept that this will save the money for beneficiaries and CMS,” said Dr. Kevin Saluck, vice president of clinical operations at Sayreville, N.J.-based Allcare Medical, and president of JAMES. “This will prove to be untrue as the average length of stay in hospitals will inevitably increase, as will hospital readmissions, thanks to problems caused by a decrease in the number of home medical equipment suppliers.  Patients and families don’t want longer hospital stays, and our Medicare system can’t afford them.”

“There is so much more to taking care of Medicare beneficiaries than the price of the item,” added Raymond Arthurs, owner of First Care Medical Supplies in Manalapan, and Vice President of JAMES. “We all know these extensive service, overhead and compliance expenses very well – and so does CMS – but they fail to recognize them even though they created many of these costs themselves.”

A broad group of 254 members of the House of Representatives has cosponsored legislation in Congress, H.R. 3790, to stop the bidding program and replace it with a fiscally responsible measure to reduce payment rates for homecare but preserve the ability of home medical providers to continue serving Medicare beneficiaries.  New Jersey Representatives who have cosponsored the bill include Robert Andrews (D), Rodney Frelinghuysen (R), Leonard Lance (R), Frank LoBiondo (R), Donald Payne (D), Steven Rothman (D), Albio Sires (D), and Chris Smith (R).  

Other organizations that support the elimination of Medicare’s bidding program for home medical equipment include the ALS Association, the American Association for Respiratory Care, the American Association of People with Disabilities, International Ventilator Users Network, the Muscular Dystrophy Association, National Emphysema/COPD Association, National Spinal Cord Injury Association, Post-Polio Health International, and United Spinal Association, among others.

Unintended negative consequences of the bidding program include:

• REDUCED ACCESS TO CARE AND SERVICE DISRUPTION – This bidding program will restrict consumer access to care and choice for home medical items and services, and it will trigger a race to the bottom in terms of quality. Less expensive items will be provided to patients. The program will disrupt the continuum and coordination of care between doctors, discharge planners, patients, and home medical equipment providers. With a loss of providers, expedient deliveries of items and services will be eliminated.

• HIGHER SPENDING IN MEDICARE – The bidding program will increase Medicare costs. It will lead to longer, more expensive hospital stays and more physician office visits, nursing home admissions, and emergency room visits.

• LESS COMPETITION, NOT MORE – The bid program is anti-competitive because it reduces the number of competitors.  About 90 percent of home medical service providers would have been barred from the Medicare program in the first round of bidding conducted in 2008.

• LOSS OF JOBS AND SMALL BUSINESSES – The bidding program will result in the closing of thousands of small businesses and result in as many as 100,000 job losses nationwide.

The Jersey Association of Medical Equipment Services (JAMES), established in 1978, disseminates information related to the delivery of Home Medical Equipment to providers of these services. It is the goal of the organization to keep its members informed of industry changes and related information necessary to maintain quality of care in providing home medical equipment, supplies and services to the patients who rely on home medical equipment.  JAMES membership is comprised of more than 70 members and manufacturers doing business in the state of New Jersey.  Visit www.jamesofnj.org or call 732-503-5665.

The Centers for Medicare & Medicaid Services issued a press release today related to the PECOS enrollment. 

CMS 6010 IFC allows the public to submit comments from May 5 through July 6, 2010.  We encourage our members to submit comments electronically.  This rule establishes that physicians must have a valid PECOS enrollment by July 6, 2010. 

JAMES members should refer to Electronic Alert Vol. 3, No. 32 for specific instructions on submitting your electronic comment. 

Wendy Russalesi, 732-503-5665, Jersey Assn. of Medical Equipment Services, wrussalesi@jamesofnj.org; 

Michael Reinemer, American Assn. for Homecare, 703-535-1881, michaelr@aahomecare.org;

Alissa Hinkson, alissahinkson@rational360.com, Rational 360, 202-470-5340  

New Jersey Home Medical Equipment Providers Call on Congress to Preserve Homecare as an Option for Seniors and People with Disabilities

Jackson, NJ, June 1, 2010 ------ Providers of home medical equipment and services across New Jersey are proposing a fiscally responsible alternative to the mislabeled “competitive” bidding scheme currently under way in Medicare that will actually discourage competition, reduce access to care for many of the state’s 1.3 million Medicare beneficiaries, and put hundreds of New Jersey homecare providers out of business.

“This bidding program is something that New Jersey’s Medicare population should be gravely concerned about,” says Wendy Russalesi, executive director of the Jersey Association of Medical Equipment Services (JAMES), which represents providers of home medical equipment in the state. “If implemented, this program will do nothing more than delay access to necessary medical equipment, reduce the quality of the medical equipment provided, and place additional economic strain on the small business community of New Jersey.  With the recent passage of the health reform bill, this program is now slated to encompass an alarming 80 percent of our state during the second round of bidding.”

The Medicare bidding program encourages “suicide bidding,” using economic coercion by forcing providers to submit unsustainable bids necessary to win a contract. Although Congress delayed the implementation of the selective contracting program in 2008 to allow for needed changes, the Centers for Medicare and Medicaid Services (CMS) ignored congressional intent and did not address the flaws that precipitated the delay.  

“For decades, durable medical equipment providers have competed in an open market on the basis of quality,” says David Ferguson, vice president and general manager of AtHome Medical in Morris Plains, N.J.  “Our differentiating factors have always been the reliability of our products, the timeliness of our service, and the expertise of our clinicians and support staff. What we observed in the 2008 program implementation, which was delayed, was nearly 90 percent of the existing providers were prevented from servicing Medicare beneficiaries.  The provision of care was awarded to some firms with little or no experience servicing the local market and those who had submitted unsustainably low rates, or ‘suicide bids,’ without thought as to the whether they could sustain care, let alone quality care.  In an environment with reduced competition, quality always suffers.”  

The bidding process is now underway in nine metropolitan statistical areas (MSAs) in the U.S., and that process begins in 91 more MSAs next year, including three MSAs that cover 80 percent of New Jersey.  

“With all of the changes the homecare sector has had to absorb over the past several years, our company has had to make some very difficult decisions regarding the services and products we can continue to offer,” states Dr. Kevin Saluck, vice president of clinical operations at Sayreville, N.J.-based Allcare Medical, and president of JAMES.  “CMS has forced us down a one-way street.  At the end of this street, we will be forced to offer lesser quality products, fewer services and unfortunately, a much different business model to our referrals and customers.” 

“Over the course of the last three years, we have increasingly moved away from Medicare business in preparation for this bidding program,” says John Gerity, CEO of Access 2 Care in Lincoln Park, N.J.  “We estimate laying off one-third to one-half of our work force if the bidding program becomes a reality.  Medicare beneficiaries will have less access to quality durable medical equipment companies, many of whom will be closing their doors.”

JAMES supports H.R. 3790, a bipartisan bill in Congress that would preserve access to homecare and provide a cost-effective alternative to a misguided Medicare “competitive” bidding program for durable medical equipment. H.R. 3790 replaces the Medicare bidding program with other types of cost-savings that will reduce reimbursements to home medical equipment providers but preserve patient access to medically required equipment and services in the home.

So far, the bill has 242 cosponsors in the U.S. House of Representatives with broad bipartisan support. More than half of both the Democratic and Republican delegations in the House support the bill.

More than half of the New Jersey delegation in the U.S. House of Representatives have cosponsored the bill: Representatives Robert Andrews, Leonard Lance, Frank LoBiondo, Donald Payne, Steven Rothman, Albio Sires, and Christopher Smith.

Patient and consumer groups that support the elimination of Medicare’s “competitive” bidding program for durable medical equipment include the ALS Association, the American Association for Respiratory Care, the American Association of People with Disabilities, International Ventilator Users Network, the Muscular Dystrophy Association, National Emphysema/COPD Association, National Spinal Cord Injury Association, and Post-Polio Health International, among others.

Proponents of the Medicare bidding program for durable medical equipment have perpetuated several myths about the program. However, the reality is quite different.

MYTH:  The bidding program will be good for Medicare beneficiaries.

REALITY: It will, in fact, reduce access to medically required equipment and services.

MYTH:  The program will eliminate Medicare fraud in the durable medical equipment sector.

REALITY: The solution to fraud is better screening of providers, real-time claims audits, stiffer penalties, and better enforcement mechanisms for Medicare – steps that the home medical providers support.

MYTH: The bidding program helps businesses by creating a more competitive environment.

REALITY:  The program coerces providers to bid at unsustainable Medicare reimbursement rates and will force thousand of businesses to close, reducing competition in the long term.

MYTH: Providers will be competing on quality and price.

REALITY: The bidding program will ration care. Home medical equipment providers already compete on the basis of quality and help move people smoothly from hospitals to cost-effective care at home.

MYTH:  The bidding program will make healthcare more cost-effective.

REALITY: The home is already the most cost-effective setting for post-acute care. As more people receive good equipment and services at home, the U.S. will spend less on longer hospital says, emergency room visits, and nursing home admissions.  

“Homecare is the preferred, cost-effective solution for those recuperating or managing their current diagnosis, and the home medical equipment provider community is an integral part of that solution,” says Russalesi.  “To dismantle that infrastructure, especially at a time when the Baby Boomer generation is entering the Medicare program in such large numbers, would be devastating to our senior population.”

For more details on the bidding program, visit www.aahomecare.org/competitivebidding

The Jersey Association of Medical Equipment Services (JAMES), established in 1978, disseminates information related to the delivery of Home Medical Equipment to providers of these services. It is the goal of the organization to keep its members informed of industry changes and related information necessary to maintain quality of care in providing home medical equipment, supplies and services to the patients who rely on us.  Our membership is comprised of more than 70 members and manufacturers doing business in the state of New Jersey.  For more information, please visit www.jamesofnj.org or contact us by phone at 732-503-5665.

It was announced on the May 19 Open Door Forum call hosted by CMS that DMEPOS providers may begin using Internet-based PECOS as of July 13, 2010. 

Providers and suppliers will be able to submit enrollment applications, view enrollment information, update enrollment information, complete the re-enrollment process, voluntarily terminate from the Medicare program, and track the status of an application submitted via the Internet.

On July 5, 2010, the enrollment data for all active DMEPOS providers will be moved from the National Supplier Clearinghouse (NSC) into the Provider Enrollment, Chain and Ownership System (PECOS). 

JAMES Members - Refer to Electronic Alert, Vol. 3, No. 27 for additional PECOS information.

CMS Getting Started Guide for DMEPOS Suppliers

The Jersey Association of Medical Equipment Services is pleased to announce they will be partnering with the Union Elks Lodge #1583 to accept donations for "Elks Camp Moore".

"Tucked away in the hills of the Ramapo Mountains, Elks Camp Moore offers a fun filled vacation away from home for children with special needs.  The primary goal of the camp is to further develop the recreational and social skills of each child.  In a relaxed and accepting atmosphere, each camper experiences new adventures, lasting friendships, and opportunities that promote independence and greater self-confidence."

Camp Moore has presented JAMES with a Wish List for their Health Center.  You may download the Wish List below.  If you would be willing to donate any of the items on the list to Camp Moore, please contact Tina Padden, JAMES Secretary or Wendy Russalesi, JAMES Executive Director to arrange the delivery of your donation.  Donations are being accepted until June 25, 2010. 

Tina Padden may be reached by dialing 908-403-4294, and Wendy Russalesi may be reached by dialing 732-503-5665.  

Camp Moore Wish List

The JAMES office received confirmation this morning from Representative Chris Smith's  (NJ-R-4) office that he has signed on as a co-sponsor to H.R. 3790 - the legislation that would repeal the competitive bidding program.

As of this morning, there were officially 218 co-sponsors of this legislation.  Representative Smith's commitment will increase the list to 219.  New Jersey now has 53% of our representatives signed on as co-sponsors

Representative Smith joins his fellow colleagues already signed on as co-sponsors of H.R. 3790:

• Robert Andrews
• Leonard Lance
• Frank LoBiondo
• Donald Payne
• Steven Rothman
• Albio Sires

Prepared by the American Association for Homecare:

A Mobility Matters bulletin, released by AAHomecare, documents the case of a 68-year-old amputee from Yucca Valley, Calif, whose Medicare claim for a power wheelchair was denied by the government.  Both his legs had been amputated; after a stroke he had the use of one “good” arm that constantly ached. 

Under Medicare regulations, power wheelchairs are supposed to last at least five years before being replaced, but this patients chair had worn out after three years from heavy use because often his power wheelchair served as both his transportation and his bed. Learn more about his story and the need for substantial changes in the way that Medicare claims for homecare equipment are handled by the Centers for Medicare and Medicaid Services.

Please download the complete press release below:

AAH Press Release: Medicare Denies Wheelchair Claim for Elderly Amputee

NHIC, Corp, the Jurisdiction A DME MAC, has published a letter from all four medical directors that addresses the need for medical documentation to support the continued medical need for DMEPOS items.

The letter can be viewed by clicking the following link:

Durable Medical Equipment - Documentation of Continued Medical Necessity 

H.R. 3790 is budget neutral legislation that would repeal the competitive bidding acquisition program for DMEPOS items.  As of today, there are 182 cosponsors on the legislation.  

Since the lobbying efforts of JAMES in Washington, D.C. on March 2 and 3, New Jersey has gained three additional cosponsors on this legislation.  The association is continuing to follow-up with offices that have yet to sign on as cosponsors.  

The following representatives are currently cosponsoring H.R. 3790, and we thank them for their support:

• Robert Andrews (NJ-1)
• Leonard Lance (NJ-7)
• Frank LoBiondo (NJ-2)
• Donald Payne (NJ-10)
• Steven Rothman (NJ-9)
• Albio Sires (NJ-13)

If your representative is not listed above, we urge you to contact their office and ask for their cosponsorship on H.R. 3790.  Resources to use during your discussions have been emailed to all JAMES member companies.

Jersey Association of Medical Equipment Services

Press Release

CONTACT:    Wendy Russalesi, 732-503-5665, wrussalesi@jamesofnj.org

New Jersey Medical Equipment Suppliers Travel to Washington to Advocate for Better Home Medical Care for Seniors and People with Disabilities

JACKSON, N.J. March 18, 2010 ------ Homecare providers from New Jersey-based home medical equipment companies travelled to Washington, D.C. earlier this month to urge members of Congress to strengthen, not weaken, homecare as an option for the millions of older Americans and people with disabilities who require home-based medical equipment and services.

“Home-based care is by far the most cost-effective setting for post-acute care,” said Wendy Russalesi, Executive Director of the Jersey Association of Medical Equipment Services (JAMES). “Quality home medical equipment and services help to reduce hospitalizations, ER visits, and admission to nursing homes.”

The group met with the state’s Senators, Frank Lautenberg and Robert Menendez, as well as New Jersey Representatives John Adler, Robert Andrews, Rodney Frelinghuysen, Rush Holt, Leonard Lance, Frank LoBiondo, Frank Pallone, Bill Pascrell, Albio Sires and Chris Smith.

New Jersey home medical equipment providers asked members of Congress to support H.R. 3790, a bipartisan bill that would preserve access to homecare and provide a cost-effective alternative to a misguided Medicare “competitive” bidding program for durable medical equipment.  

“This bidding program is actually anti-competitive,” said Russalesi. “It will ultimately put many of the best community-focused providers out of business, eliminating competition in the long run. It also promotes irresponsible ‘suicide bidding’ using economic coercion to force providers to bid at unsustainable reimbursement rates. For providers here in New Jersey, it’s a job killer. Coming on top of the many other reimbursement cuts our sector has suffered, this bid program will reduce services that Medicare beneficiaries need.”

H.R. 3790 would replace the Medicare bidding program with other types of cost-savings and at the same time preserves access to home-based care. The bill currently has 182 cosponsors in the U.S. House of Representatives, with strong bipartisan support that includes roughly equal proportions of Democrats and Republicans as cosponsors.  Congressmen Andrews and Lance became the latest New Jersey legislators to sign onto the bill as a result of the meetings in Washington.  They join New Jersey Representatives LoBiondo, Payne, Rothman and Sires as cosponsors.

Russalesi was among several hundred providers of home medical equipment gathering in Washington at a conference hosted by the American Association for Homecare, which represents providers of home medical equipment and services. 

JAMES is New Jersey’s leader in medical equipment advocacy and education, representing more than 70 member companies serving patients and communities across the state.

Myth vs. Reality

Facts about Medicare’s

“Competitive” Bidding Program for

Homecare Medical Equipment

CMS has been touting the merits of the Medicare competitive bidding program for durable, or home medical equipment and services (HME) with messages to convince lawmakers that this suicide bidding program is good for seniors. Unfortunately, CMS has conveyed misleading information and cherry-picked facts that ignore the realities of what will happen if this program moves forward.

MYTH #1: The bidding program is good for beneficiaries because it will significantly reduce cost-sharing requirements.

REALITY: Patient copayments for home medical equipment have fallen dramatically for many years along with decreasing home medical equipment reimbursement rates.  A bipartisan bill in the House, H.R. 3790, would eliminate the bidding program in a fiscally responsible manner by reducing home medical reimbursements to offset savings that the bid program would have realized. So the effect of that bill, which has 173 cosponsors so far, would be a further reduction in copayments for Medicare patients.  Moreover, most beneficiaries have Medigap policies that cover copayments, so insurance companies will be the primary beneficiary of the lower copayments. More importantly, low copayments come at a great cost in terms of reduced access and service. The bidding program will trigger a race to the bottom in terms of care for seniors and people with disabilities.  The bid program will ultimately increase doctor visits, hospital stays, and nursing home admissions, which in turn will increase copayments and other costs for patients and for Medicare.

MYTH #2: The bidding program will eliminate fraud in the durable medical equipment sector.

REALITY: To characterize the bidding program as an anti-fraud mechanism is extremely misleading. The real solution to keeping criminals out of Medicare is better screening, real-time claims audits, and better enforcement mechanisms for Medicare. The American Association for Homecare has proposed an aggressive 13-point plan to combat fraud (www.aahomecare.org/stopfraud) and many of those provisions are included in two bills in Congress.  The Association endorses Sen. George LeMieux’s anti-fraud legislation, The Prevent Health Care Fraud Act of 2009 (S. 2128), and its companion bill in the House, H.R. 4222.  Also two new requirements that took effect in October 2009 – accreditation and surety bonds for home medical equipment providers – will go far toward eliminating fraud. 

MYTH #3: The bidding program is good for business because it creates a more competitive environment.  

REALITY: The program requires “suicide bidding” that coerces providers to bid at unsustainable Medicare reimbursement rates.  At a time when the government is working to create jobs, the bidding pogrom is a job killer. In the first round of the program in 2008, 90 percent of qualified providers were barred from serving Medicare beneficiaries for the bid-upon items, even if they had agreed to the lower Medicare rates.

MYTH #4: Providers will be competing on quality and price.

REALITY: The “competitive” bidding program will, in fact, ration care. Home medical equipment providers already compete on the basis of quality in order to help in the hospital discharge process, which moves patients into cost-effective, post-acute care at home. The way this bidding program is set up triggers a race to the bottom in terms of quality and because losing the bid means going out of business, providers must engage in suicide bidding that coerces them to bid at economically unsustainable rates.  This will increase Medicare spending in hospitals and ER visits.

MYTH #5: The bidding program will make healthcare more cost-effective.

REALITY: The home is already the most cost-effective setting for post-acute care. As more people receive good equipment and services at home, we will spend less on longer hospital says, emergency room visits, and nursing home admissions.  Home medical equipment is an important part of the solution to the nation’s healthcare funding crisis. Home medical equipment represents less than two percent of Medicare spending. So while this bidding program may further reduce reimbursement rates for home medical equipment, ultimately, it will increase Medicare and Medicaid spending for hospitals, physicians, nursing homes, and emergency treatments.

Prepared by the American Association for Homecare, March 10, 2010.

Currently, there are two key pieces of legislation affecting our membership.  H.R. 2373 seeks to restore oxygen payments through the Medicare beneficiary's period of need.  H.R. 3790 seeks to repeal the competitive bidding acquisition program for durable medical equipment, prosthetics, orthotics and supplies (DMEPOS) in a budget neutral manner.

There are 82 co-sponsors on H.R. 2373 and 145 co-sponsors on H.R. 3790.  Representatives Frelinghuysen (R-NJ-11), LoBiondo (R-NJ-2), Rothman (D-NJ-9) and Smith (R-NJ-4) have offered support on H.R. 2373.  Representatives LoBiondo (R-NJ-2), Payne (D-NJ-10), and Rothman (D-NJ-9) have offered support on H.R. 3790.  If your representative is listed as a co-sponsor, please send a thank you to them.  If your representative is not listed as a co-sponsor, please contact their office to ask for their support. 

You may locate your member of Congress and their contact information by logging onto www.congress.org.

JAMES will be attending the American Association for Homecare Legislative Conference in Washington, D.C., March 1 - 3, 2010.  JAMES currently has confirmed appointments with Senators Lautenberg and Menendez, as well as several members of the House of Representatives.  Members - please check your Electronic Alert emails for a detailed schedule.

H.R. 2373 Bill Language

H.R. 3790 Bill Language

All JAMES members must renew your 2010 membership today to avoid the suspension of email Alerts and membership benefits.  

Please call the JAMES office today at 732.503.5665 if you have not renewed your membership!

Jim Bossenmyer, director of the Division of Provider/Supplier Enrollment of CMS, announced on a Special Open Door Forum teleconference on February 17, 2010, that implementation of CR 6417 and CR 6421, will be delayed until January 3, 2011.

DMEPOS claims that were ordered or referred by a physician or non-physician provider type that was not enrolled in PECOS were going to begin rejecting on April 5, 2010.  The new date for this to occur is now January 3, 2011.

While the additional delay to phase 2 implementation is significantly greater than the original delay of 90 days, CMS representatives on the February 17 Special Open Door Forum teleconference recommend that physicians and non-physician provider types that have yet to enroll in PECOS begin the process now, or at least within the next month.

This action should ensure that they are accurately enrolled in PECOS by the new implementation date for phase 2. 

An overview of the PECOS requirement can be found by logging onto the CMS website.

The JAMES Board of Directors is supporting the third round of efforts to gain co-sponsorship of HR 3790 by the National Associaton of Independent Medical Equipment Suppliers (NAIMES).  This legislation was introduced by Kendrick Meek (D-FL-17) and will seek to repeal the competitive bidding program.  Previous efforts to gain co-sponsorship on this bill have included VGM's "Shut Down the Switchboard" and the American Association for Homecare's "Meek Week".

There are currently 140 co-sponsors on the legislation and the industry is seeking a minimum of 218 co-sponsors.  There are three representatives from the New Jersey delegation currently co-sponsoring HR 3790.  We would like to thank Representatives  Frank LoBiondo (R-NJ-2), Donald Payne (D-NJ-10) and Steven Rothman (D-NJ-9) for their support on HR 3790.

SOS Week is running from February 12 - 22, 2010.  Please call your Representative between these dates and ask for their co-sponsorship of HR 3790. Try to reach them in the local district office during the President's Day Recess by visiting them at their office or inviting them to your business.  JAMES can offer assistance in developing the agenda for your site visit!

After reaching out to the local office of your Representative, also contact the Health Legislative Aid in the Washington, D.C. office.  Contact information for both the local and Washington, D.C. office of your representative can be obtained by logging onto Congress.org.

Complete details for SOS Week can be found by clicking here.  Please be sure to contact the JAMES office at 732.503.5665 if you require any assistance and to keep us informed of your progress with your individual member of Congress.

State Associations such as JAMES are working together through the American Association for Homecare's State Leaders Council to gather information to share with CMS regarding PECOS edit warnings.  

The Council has created a survey with a brief explanation asking HME companies to provide the percentage of cliams with the edit warning (PECOS).  This survey was originally developed by the Region A Council, but has been expanded nationwide.

An electronic link to the survey has been provided to JAMES members in the JAMES Electronic Alert Vol. 3, No. 6, dated January 29, 2010.  Please check your email inbox! This survey needs to completed by the close of business on Friday, February 5, 2010.

 JAMES “Help for Haiti” Produces an Impressive Outpouring of Support

Approximately $100,000 in medical equipment and supplies collected for donation

JACKSON, NJ, January 29, 2010 -  Raymond Arthurs, vice president of JAMES and owner of First Care Medical Supplies, worked together with JAMES executive director, Wendy Russalesi, to collect approximately $100,000 in donated medical supplies and equipment from its membership.  The medical supplies and equipment will be donated to aid the victims of the earthquake that struck Haiti on January 12, 2010.

“I was watching the news about the Haiti earthquake aftermath and Julia, my eight year old daughter said to me, ‘Daddy, you have to help these people.’  That was enough to set the wheels in motion,” said Raymond Arthurs.  Ray contacted the JAMES Board of Directors, who agreed that the association should do their part to contribute.  “Even though the association mostly consists of independent medical equipment providers who, like any business, face uncertain economic times, I felt it was important that the membership band together to help those who are less fortunate than us,” said Dr. Kevin Saluck, president of JAMES.  JAMES reached out to its membership through fax, e-mail and website communications to let members know the details of “Help for Haiti” and how they could participate.

The Marlboro, NJ location of Secure Self Storage provided a drop-off location for JAMES members to bring their donations to.  First Care Medical Supplies of Manalapan, NJ, provided vehicles and staff that did pick-ups of donations at JAMES member locations throughout the state of New Jersey.

“To collect the amount of medical equipment and supplies that our association did in such a short period of time displays a remarkable humanitarian commitment from our membership,” said Wendy Russalesi.

The medical equipment and supplies were delivered to Marcy Sasso, director of operations at the Ambulatory Surgical Center of Union County on Tuesday, January 26, 2010.  Ms. Sasso is coordinating with NJ 4 Haiti to transport the medical supplies and equipment to Haiti.

The Jersey Association of Medical Equipment Services (JAMES), established in 1978, disseminates information related to the delivery of Home Medical Equipment to providers of these services. It is the goal of the organization to keep its members informed of industry changes and related information necessary to maintain quality of care in providing home medical equipment, supplies and services to the patients who rely on us.  Our membership is comprised of more than 70 members and manufacturers doing business in the state of New Jersey.  For more information, please visit www.jamesofnj.org or contact us by phone at 732-503-5665.

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The JAMES Board of Directors would like to request the assistance of our member companies in helping the people of Haiti in their desperate time of need.

At the top of the list of necessary items for the recovery efforts are medical supplies and non-perishable food items, including bottled water.

According to news reports, the most needed medical supplies are gauze, bandages and IV supplies.  Also according to news reports, the most ocmmon injuries after a natural disaster of this type are amputations and bone fractures.  For this reason, donations of mobility enhancing equipment would be necessary as well.

Raymond Arthurs of First Care Medical Supplies, Vice President of JAMES, is coordinating efforts with the JAMES Board of Directors to pick up donations at JAMES member company locations. 

Here is what we are asking from our members:

• Provide JAMES with a detailed inventory, including quantities, of what your company is donating

• Contact the JAMES office beginning today and throughout the weekend by fax or email with your inventory list

• Provide the complete physical address of where your supplies are located for pick up, as well as the phone number, contact name and hours of operation

• Have supplies available for pick up beginning Monday, January 18, 2010.

The JAMES office will contact your company to advise when your pick up has been scheduled.  Donations will be delivered for our member companies on Tuesday, January 26, 2010, to the Ambulatory Surgical Center of Union County.  This facility is coordinating with NJ 4 Haiti to transport the medical equipment and supplies to Haiti.

 JAMES Facilitates Legislative Visit to a New Jersey HME Site at the Request of Representative Frank Pallone’s Office

Extended visit focused on the value of homecare 

JACKSON, NJ, January 7, 2010 -  Tiffany Guarascio, Legislative Director for Representative Frank Pallone’s Washington, D.C. office contacted the Jersey Association of Medical Equipment Services, and expressed interest in visiting a home medical equipment (HME) provider in their district.  JAMES general member, Allcare Medical, hosted the educational site visit at their corporate headquarters located in Sayreville, New Jersey.  Allcare Medical is a full service HME provider, with a scope of service that includes respiratory equipment and supplies, power mobility and custom rehab products, and orthotics and prosthetics. 

Originally scheduled for a two-hour visit, Ms. Guarascio extended her time at Allcare Medical to well beyond three hours.  Ms. Guarascio received an extensive tour of Allcare Medical that included a visit to their retail site, distribution warehouse and corporate offices.  During this time, Ms. Guarascio met with staff at all levels in the operations of Allcare Medical, each one taking the time to detail their role within the organization and answer Ms. Guarascio’s questions.  Ms. Guarascio was able to understand the flow of operations and experience the efforts that are required to service an HME patient from the initial receipt of an order, all the way through to any follow-up maintenance and services that the patient may require.  Allcare Medical staff was able to accurately detail the measures that are taken by the organization to ensure they are meeting compliance with the CMS Quality Standards, the DMEPOS Supplier Standards and the standards of their accrediting body, as well as all state and federal guidelines that are applicable to their operations.  Most importantly, they were able to help Ms. Guarascio understand all of the transparent services that are not separately reimbursable, but are a necessity for the delivery of a durable product.  It was evident to Ms. Guarascio that an HME provider is an integral part of helping to keep the patient in their preferred home setting while they recuperate or manage their medical condition. 

“I felt we had a very productive meeting with Tiffany Guarascio, Frank Pallone’s Legislative Director.  She seemed very interested during our tour and round-table discussion, and asked many very good questions.  In our discussion session, we had a dozen of our key managers and clinicians introduce themselves and discuss their position within our organization.  We were able to show Tiffany that many professionals, clinicians and staff are required - and the cost to the organization - to provide care and services to the Medicare beneficiary,” said Richard Lerner, Allcare Medical President. 

Also during the round-table session of the visit, the concerns of the industry regarding the competitive bidding program, the current 36-month oxygen cap and the preservation of the first month purchase option for power mobility were discussed with Ms. Guarascio.   A power mobility patient was present to discuss how Allcare Medical has helped her over the past decade, and phone testimonials were provided to the group by two long-term respiratory patients.

Dr. Kevin Saluck, Vice President of Clinical Operations for Allcare Medical and JAMES President stated, “During the discussion of the complexities of the 36-month oxygen cap, Ms. Guarascio was taken aback by the fact that we are expected to supply oxygen and services to Medicare beneficiaries that travel, and that we have no representation in the state that the beneficiary travels to.”

“I believe Ms. Guarascio was given an essential education in the necessary role that our member companies play in the value of homecare. The costs involved with providing the level of service that our industry’s regulations have placed on an HME provider – costs that have gone as unrecognized by our policymakers - were largely on display for Ms. Guarascio.  It was apparent during this site visit that there is a significant focus by the HME provider on providing timely access to quality home medical equipment and services,” said Wendy Russalesi, JAMES Executive Director.

The Jersey Association of Medical Equipment Services (JAMES), established in 1978, disseminates information related to the delivery of Home Medical Equipment to providers of these services. It is the goal of the organization to keep its members informed of industry changes and related information necessary to maintain quality of care in providing home medical equipment, supplies and services to the patients who rely on us.  Our membership is comprised of more than 70 members and manufacturers doing business in the state of New Jersey.  For more information, please visit www.jamesofnj.org or contact us by phone at 732-503-5665.

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This is “Meek Week” – an ideal time to meet with your members of Congress while they are back in their home districts and ask them to support Rep. Kendrick Meek’s bill, H.R. 3790, to eliminate the “competitive” bidding program. By drastically cutting reimbursement rates and number of home medical equipment firms allowed to participate in Medicare, the bidding program promises to cripple the nation’s homecare sector – the most affordable, cost-effective form of health care available to Americans.

Later this week, a JAMES member company in Representative Pallone's district will be hosting an educational visit for Mr. Pallone's Legislative Director from the Washington, D.C. office.  The opportunity will be used to provide education about the HME industry, and the value our industry adds to homecare. 

Jersey Association of Medical Equipment Services Elects New Executive Board, Fills Board Vacancies

Press Release – November 30, 2009

Jackson, NJ - On November 19, 2009, at the JAMES Annual Conference, "The Tides of Change", a new Executive Board of Directors was elected.  Elections were also held to fill expired board positions, as well as board vacancies.

Elected to our Executive Board of Directors:

Dr. Kevin Saluck, President, Allcare Medical

Raymond Arthurs, Vice President, First Care Medical Supplies

Tina Padden, Secretary, Community Surgical Supply

Ben Hertz, Treasurer, Elmora Pharmacy

Elected to our Board of Directors:

Josh Parnes, Ocean Home Health

Seth Auerbach, Komfort & Kare

Vikram Patel, DeRosa Pharmacy

Jeffrey Reses, Lincoln Medical

Elected as our Associate Board of Director:

 Gary Brown, Invacare

Bob Miller of Bach's Home Health Care and Ron Manno of Core Care Technologies are also serving in current terms of office on the Board of Directors.

Elections will be held at our 2009 Annual Conference, "The Tides of Change", on November 19, 2009. 

At this time, there are four board positions that will need to be filled, and the terms of the Executive Board are expiring.  If you are interested in serving on the JAMES Board of Directors and your company is a JAMES General Member, please complete the nominating ballot available for download below.

The ballot must be returned by fax to the JAMES office by November 5, 2009.  The fax number is 732.833.2029.

If you would like information regarding the responsibilities of being a JAMES Board Member, please contact the JAMES office at 732.503.5665.

JAMES 2009 Nominating Ballot

This week, H.R. 3790 was introduced by Congressman Kendrick Meek (D-FL).  This is a budget neutral, bi-partisan bill that would repeal the DMEPOS Bidding Program.

While New Jersey is not in any of the Round One MSA's of the DMEPOS Bidding Program, it is in Round Two.  There is the very real potential that 13 out of New Jersey's 21 counties will be affected by this program.  

The JAMES Board of Directors realizes the devastating affects that this program will have on New Jersey and is asking all JAMES member companies to contact their legislators to co-sponsor H.R. 3790.

As of December 9, 2009, there are 97 co-sponsors signed onto H.R. 3790.  Representative Frank LoBiondo (R-NJ-2), Representative Steven Rothman (D-NJ-9) and Representative Donald Payne (D-NJ-10) have signed onto this legislation as co-sponsors.

Please continue to urge your representatives to support this legislation! 

H.R. 3790 Summary Page

Join JAMES by October 1, and sample the full benefits of General Membership for only $250 for the remainder of 2009!

There are numerous advantages to supporting your state association as a General Member, some of them highlighted below:

                                         General Membership

• Annual Conferences and Educational Seminars - Reduced Rates
• Participation in the American Association of Homecare's State Leaders Council, Medicare Jurisdiction A Council, and the Medicare Provider and Outreach and Advisory Group
• Legislative Assistance and Representation
• Medicare and Medicaid Intermediary
• Electronic Alerts - an emailed publication that alerts you to the most up-to-date industry information
• Members Only Area access on our website - use the forums to discuss current events and issues within the industry with other members, view meeting minutes and archived information
•  Access to JAMES General Counsel, David Barmak, Esq., at a reduced hourly rate

The JAMES Board of Directors invites you to complete an application for General Membership prior to October 1, 2009, and we will pro-rate your dues to the rate of $250!  Your company will receive the full benefits of membership, and you will qualify to receive the JAMES Member Rate at our upcoming 2009 Annual Conference, scheduled for November 18 - 19, 2009.

JAMES Membership Application

JAMES Membership Drive

JAMES Credit Card Authorization

On Monday, July 13, 2009, Dr. Kevin Saluck, JAMES Vice President attended Congressman Rush Holt's healthcare reform round-table discussion.  JAMES was chosen by Congressman Holt to represent the medical device/equipment stakeholders. 

Congressman Holt is a representative on the House Tri-Committee for healthcare reform.  The expectation is that the House will pass this bill by the end of July.  It is the highest priority of the President to pass a $900 billion healthcare reform by the end of this year.

As of July 23, 2009, there are 74 co-sponsors signed onto HR 2373.  Representatives from NJ that have signed on are:

Rodney Frelinghuysen (D-NJ 11), Christopher Smith (D-NJ 4),Steven Rothman (D-NJ 9), Frank LoBiondo (R-NJ2)

Through the efforts of the North Carolina Association for Medical Equipment Services (NCAMES) and the Georgia Association of Medical Equipment Services (GAMES), the Home Oxygen Patient Protection (HOPP) Act of 2009, H.R. 2373, was introduced in the House on Tuesday evening.  The legislation is sponsored by Rep. Heath Shuler (D-NC) and Rep. Tom Price (R-GA).  This will repeal the cap on home oxygen therapy that was enacted as part of the Deficit Reduction Act of 2005.  Price introduced a similar bill in the 110th Congress, H.R. 621, which attracted 143 cosponsors. 

Democratic legislators should contact the office of Rep. Heath Schuler (D-NC) and Republican legislators should contact the office of Rep. Tom Price (R-GA) to become a cosponsor on this legislation.

Please contact the JAMES office if you require any assistance or need talking points for HR 2373.

HR 2373 Press Release NC GA

HR 2373 Bill Language

We would like put out a reminder that our courtesy forwards to our new phone number, fax number and mailing address have ceased.  Please check your records to ensure that you are using the current JAMES contact information:

• Phone Number:  732.503.5665
• Fax Number:       732.833.2029
• Mailing Address:  PO Box 38,  Jackson, NJ  08527
• Email Address:  info@jamesofnj.org

JAMES representatives will be attending the American Association for Homecare's Legislative Conference, June 1 - 3, 2009.  The JAMES office will be working to schedule lobbying appointments for June 3, 2009. 

If your company will be attending this conference, please contact the JAMES office at 732.503.5665 so that we may coordinate our appointment schedules for June 3, 2009.

If your company will not be able to be present in Washington, D.C. on June 3, 2009, we urge you to follow-up with your local legislative office here in NJ on that date.  Contact information can be found for the local offices by logging on to http://www.congress.org/.

JAMES 2009 Washington DC Legislative Contacts

The following Congressmen from New Jersey have signed onto the Dear Colleague Letter in support of rescinding the competitive bidding program:

• Christopher Smith
• John Adler
• Albio Sires
• Frank LoBiondo

Please follow-up with your contacts in these offices to thank them for their support.

The deadline to have your congressperson sign onto the Dear Colleague letter initiated by Congresswoman Betty Sutton has been extended to 12 noon on Tuesday, April 14, 2009.

This letter urges CMS and the White House to rescind the competitive bidding interim final rule that is to take effect on April 18, 2009.

House Dear Colleague and Sign-On Letter to Rescind Competitive Bidding April 2009

The JAMES Board of Directors would like to thank everyone who attended the "Medicare & Medicaid Billing Day" on April 2, 2009.

Due to the large number of attendees at the program, we want to be sure that everyone was able to get the assistance that they needed from the representatives that were on-site that day. 

If you still have a situation that needs resolution or have a question that needs to be answered, please contact the appropriate JAMES representative:

• Medicare Committee Chairperson:  Tina Padden
• Medicaid Committee Chairperson:  Ben Hertz
• Medicaid Committee Co-Chairperson:  Bob Miller

You can email Tina, Ben or Bob by navigating to the Contact Us page on this site.

Please feel free to contact the JAMES office at 732.503.5665 if you need additional assistance.

The JAMES Board of Directors would like to remind you of the importance of scheduling an appointment with your local legislative district office between the dates of April 6, 2009 - April 17, 2009. 

Please contact the JAMES office at 732.503.5665 if you need assistance in locating the contact information of your corresponding district office, with scheduling an appointment or with talking points to use for discussion during your appointment.

The surety bond requirement is now a reality and the JAMES Board of Directors is pleased to announce that we have partnered with VGM Insurance to offer our members the opportunity to purchase a low cost surety bond. 

Please contact the JAMES office via phone or email for information on how to ensure you receive the appopriate rate before applying for your surety bond!

JAMES Office - 732.503.5665

The JAMES Board of Directors is pleased to announce that the association will now be offering installment options for General Membership Dues. 

Your company can choose between semi-annual payments or quarterly installments.  Please contact the JAMES office at 732.503.5665 for additional details.

The Jersey Association of Medical Equipment Services (JAMES) is now announcing that its physical transition is complete and has a new address, phone and fax number.

The JAMES Board of Directors is pleased to announce that the association is now offering installment payments and a reduced deposit for all new companies applying for JAMES membership. 

Please download the 2009 Membership Drive information sheet for more details!

JAMES 2009 Membership Drive

The JAMES Board of Directors is pleased to announce that Mr. Bob Miller and Mr. Ron Manno have both been unanimously re-elected to three-year Board of Director positions. 

Congratulations to Mr. Miller and Mr. Manno!