Accreditation deadline delay sounds industry praise, relief
The good news for neighborhood pharmacists is that Congress passed a bill extending the Medicare accreditation deadline for durable medical equipment through the end of the year while those on Capitol Hill attempt to draft the comprehensive healthcare reform legislation.
H.R. 3663, as introduced by Reps. Zack Space, D-Ohio, and Lee Terry, R-Neb., passed the House and Senate in early October. The president signed the bill into law Oct. 13.
Currently, language in much of the reform legislation under consideration would include pharmacies among their healthcare professional peers as exempt from any accreditation requirements because they “[prove] to be onerous, expensive and duplicative for community pharmacists, who already must meet state licensing requirements,” the National Community Pharmacists Association stated. Pharmacists have not been associated with the fraud targeted by the regulations, the NCPA argued, but yet are the only licensed healthcare providers not yet exempted.
“The Senate acted wisely to ensure seniors can continue purchasing essential medical supplies from their community pharmacies,” stated Bruce Roberts, NCPA EVP and CEO. “Without it, thousands of independent community pharmacies would be forced to stop supplying diabetes testing supplies and other products to their patients.”
The bad news? The deadline for the $50,000 surety bond requirement for pharmacies interested in billing for Medicare Part B only had been extended a few days, maybe a week, when this news broke in October. And there is some confusion around whether or not, because of H.R. 3663, the surety bond requirement has been waived through the end of the year as well.
Bill Popomaronis, VP long-term and home healthcare pharmacy services for the NCPA, suggested that to the best of his understanding, H.R. 3663 did not extend the surety bond deadline, and that those pharmacies that have not secured a surety bond in time will need to wait one year before they can apply for a Medicare Part B number again. Because of poor communication out of the Centers for Medicare and Medicaid Services, many pharmacies did not recognize that the lack of a surety bond would prevent them from billing Medicare Part B, he said. And that means, those pharmacies that have decided to no longer provide DME under Medicare Part D (including diabetes supplies) or the Medicare Part B drugs that coincided with that business (inhalation and immunosuppressant drugs) also would no longer be able to bill for any Medicare Part B drug, which includes many specialty pharmaceuticals, as well as drugs for such chronic diseases as asthma or COPD.
To be clear, Popomaronis said, pharmacies looking to bill under Medicare Part B (specialty drugs) will need only to produce a surety bond. Pharmacies looking to keep their DME business, such as diabetes supplies, need to have a surety bond now and accreditation by the end of the year, per this new bill.
Both Medicare Parts D and B could account for as much as 50% of an independent’s business, Popomaronis said. Out of more than 20,000 independent pharmacies today, slightly less than half have either become accredited or are in the process of gaining accreditation, Popomaronis said.
“In the debate over healthcare reform legislation, [the National Association of Chain Drug Stores] continues to advocate for an exemption for pharmacy from this accreditation requirement, as well as from the surety bond requirement—exemptions that have been afforded to other healthcare providers,” stated NACDS president and CEO Steve Anderson.
Handicapping the odds that both accreditation and surety bond exemption will be included in the final healthcare reform legislation, industry insiders told Drug Store News that accreditation exemption likely is to survive the Congressional debate. However, only the House of Representatives is including a provision for a surety bond exemption, which means a complete surety bond exemption is unlikely.