Medicare slammed for limiting pay for oxygen

Washington -- An influential lawmaker has joined suppliers of oxygen therapy equipment in calling on the Centers for Medicare & Medicaid Services to reconsider a new regulation that caps Medicare payments for home oxygen supplies at 36 months.

The regulation, which took effect Jan. 1, dictates that suppliers are still responsible for maintenance and repair of oxygen equipment for an additional two years after the 36 months of service are up. Suppliers are also responsible for beneficiaries' needs if they move away from home for an extended period. This regulation comes on top of a 9.5% cut to payment for oxygen therapy that also took effect Jan. 1.

In a March 18 letter to CMS, House Minority Leader John Boehner (R, Ohio) said stopping payment after 36 months will jeopardize quality of care for beneficiaries.

"Not only does this policy potentially harm the current care that many Medicare beneficiaries are receiving, but oxygen providers may be forced to make difficult decisions and reduce services that these beneficiaries and their physicians traditionally rely upon," Boehner wrote.

Suppliers say the new rule does not take into consideration potentially expensive maintenance, such as the need to provide multiple oxygen cylinders per month for certain beneficiaries.

"We understand the need to be responsible to the taxpayers, but I'm sometimes losing as much as $375 per patient a month," said John Reed, chief operating officer and executive vice president of PRO2 Respiratory Services, a respiratory services company based in Cincinnati, Ohio. His firm provides home oxygen services for about 1,400 Medicare beneficiaries.

Reed said his company recently had to provide nearly $300 per month in services for a patient who spends the winters in another state.

CMS insists that any medically necessary supplies provided during the additional two-year period are covered by the monthly rental and service rates paid to the oxygen supplier during the first three years.

However, the American Assn. For Homecare, which represents durable medical equipment suppliers, says CMS "does not recognize any costs associated with visiting patients who require episodes of unscheduled emergency services."