Changes for
Medicare
Thirty years ago, home oxygen was often
provided by liquid oxygen.
Oxygen concentrators were coming on strong in the 1990s and
very profitable for the Durable Medical Equipment (DME) suppliers.
In the mid-90s to 2006 Congress put pressure on Medicare
to change how they were paying for oxygen deliveries and oxygen
equipment to save money. Concentrators
began replacing liquid oxygen.
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On January 1, 2006, “the Centers for
Medicare & Medicaid Services (CMS) issued a final rule that changes
how Medicare will pay for oxygen and oxygen equipment and capped
rental items and establishes new protections for beneficiaries who
need these items.
Oxygen and oxygen equipment and capped rental items are paid under
the Medicare Part B durable medical equipment (DME) benefit.
The final rule implements Section 5101 of the Deficit
Reduction Act (DRA) requiring suppliers to transfer title of oxygen
equipment to the beneficiary after 36 continuous months and capped
rental items after 13 continuous months of rental payments.
This policy change, which is required by the Deficit
Reduction Act of 2005 (DRA), will reduce
Medicare expenditures and beneficiary coinsurance payments for the
affected items of DME.
In addition, as part of this rule, CMS is
using its statutory authority provided by the Balanced Budget Act
1997 (BBA) to establish separate payment classes and monthly
payments for oxygen generating portable equipment (OGPE).
OGPE are new, alternative oxygen equipment technologies that
meet all of the patient’s oxygen needs without delivery of oxygen
contents. CMS also used
its authority to create separate classes for oxygen contents for
stationary and portable oxygen equipment, resulting in an increase
in the monthly payment amount from approximately $20.77 to $77.45
for delivery of portable oxygen contents for beneficiary-owned tanks
and cylinders. These
policies are intended to implement the DRA payment changes for
oxygen in a way that does not eliminate the incentive for suppliers
to provide new cost-effective oxygen equipment technology and to
ensure beneficiary access to portable oxygen contents in the event
that they are still using traditional portable oxygen systems.
From CMS.gov
Newsroom
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Medicare expenditures and beneficiary
coinsurance payments for the affected items of DME were reduced
which was the main goal for CMS, not the health of those with COPD
or other respiratory disorders.
The CMS final rule also ushered the domination of home and
portable concentrators while almost ending the use liquid oxygen.
Home concentrators supply supplemental oxygen almost as well
as tanks or liquid oxygen.
OGPE, commonly called pocs today, are unable to supply the
mobile oxygen needed by most while tanks and liquid oxygen can.
Change POC Settings to Equal LPM
Now Medicare needs to start bringing
liquid oxygen back. It
will allow those who need it to have a higher quality of life,
remain healthier, and have fewer hospitalizations!
In the short term suppling liquid oxygen will cost Medicare
money, but in the long term it will save money.
Many studies show that when people with COPD are active, have
a higher quality of life and are healthier there are fewer
hospitalizations.
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Fast forward to 2020.
“Medicare covers oxygen equipment by renting it in
five-year cycles, beginning when the individual first receives the
oxygen equipment. Although
the rental period is for five years, Medicare only pays a monthly
fee to the supplier for the first three years of the cycle.
This fee is a prospective
bundled payment, meaning it covers delivery, back-up equipment,
maintenance, supplies, and accessories in one payment.
Like other Part B services,
Medicare only covers 80% of the rental fee, so individuals with
Medicare or their secondary insurer are responsible for the other
20%. Once the three years is
up, Medicare (and any individual responsible for the 20%
coinsurance) will stop paying the monthly rental fee but will still
pay for oxygen tank refills and maintenance for the last two years
of the cycle.
Even if the individual moves, exchanges
their oxygen equipment, switches from tanks to a portable oxygen
concentrator, or moves to a different supplier, their five-year
cycle continues without restarting. As
a result, it can be very difficult for individuals to find a new
supplier after a contract has started, since the new supplier will
not be receiving the full three years of payments but will have to
provide services for whatever is left of the five-year cycle. In
cases like this, the supplier who received the prospective bundled
payment should make arrangements to have a new supplier begin
covering the oxygen.”
From Medicare
Advocacy Toolkit, Oxygen Equipment, summer 2020.
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I see no advantage in the five-year contract
for consumers of supplemental oxygen.
A more flexible system is needed!
Liquid oxygen is not being taken advantage of in getting
individuals like myself the oxygen we need.
If you are on supplemental oxygen and pocs
won’t supply you with the oxygen you need, let your Physician know.
Ask for a prescription for liquid oxygen.
If you are unable to get liquid oxygen, go to your congress
person. Ask family,
friends and caregivers to do the same the same.
We need liquid oxygen as an OPTION!!!