Medicare Oxygen changes

[Guest]

This is somewhat OT, but I think there are a few people here who use Oxygen along with their PAP machine.
As of 1 Jan, 2009 Medicare will implement a modified capped rental policy for Oxygen. Medicare will rent the Oxygen equipment for 36 months, after this time frame the beneficiary retains possession of the equipment and it must be maintained by the DME who provided it.

At first glance this policy seems to be in the best interest of the beneficiary, however a beneficiary who has reached the 36 month cap and than moves, must return the equipment to the provider and restart service at another location.
Since Medicare will only start a new 36 month rental period every 5 years, if you move before the 60 months are up, you will pay for the Oxygen equipment at your new location out of pocket. Considering Oxygen equipment can run $150-$500 a month for the rental, this will be a major expense for a lot of Medicare beneficiaries.

[Slinky]

akcpapguy, are you SURE about this bit if we move during those 5 years and thus have to go w/a different local DME supplier "we" will have to pay the rental out of pocket for the balance of those 5 years??? This doesn't seem "kosher" and wasn't the way it has been explained to us by an RT at effortslist.org

If your interpretation is correct its time all efforts members as well as all 02 supplementation users to get on the stick and lobby Congress and Medicare HARD!

[Guest]

Sorry about the late answer Slinky, work got hectic at the end of the day. That is the way it was explained to us from the Medicare folks. We specifically asked, "If a patient comes to us after the 36th month of rental, can we start a new rental if they were in a different region" The answer was NO, they would have to pay for the Oxygen themselves.

[papdad]

Am on supplemental oxygen and CPAP. Have an Invacare Homefill system which consists of an oxygen concentrator and a compressor that compresses the oxygen into small carry around bottles (have 3). While I am home I use oxygen from the concentrator and have a tee for the CAPA hose to input oxygen while I sleep -- or try to that is. When I am not at home I take the small bottles with me -- they last 3 to 5 hrours each depending on the setting. After the point where Medicare stops renting and actually pays for the Invacare system, then the system is mine. After Medicare buys the equipment my DME still services the machines -- stops by, fills out form and bills medicare -- and supplies necessary hoses, etc. which medicare pays for. If I should have to move out of the region then I would take the equipment with me. It is my understanding that another DME would take over servicing the equipment and providing necessary supplies which Medicare would pay for. Is this not correct ?
NB

[Slinky]

That certainly is the way it SHOULD be, PAPDad. But, AKCPAPGuy is no slouch and a professional and according to him it was
Medicare folks providing the info to him.

I would suggest that it would be a wise idea for those of us on 02 to contact our federal legislators and ask that their legal staff check into this and give us a clear interpretation of these guidelines.

[Guest]

Slinky,

I checked with both of my Medicare reimbursement specialists this morning and they assured me that the scenario I stated above is exactly how it will happen.

If you move out of your Oxygen providers service area after the 36th month and before the 60th month, you will be responsible for payment of your Oxygen yourself. Now how much you will have to pay will be pased on the provider you choose.

[rested gal]

Good grief! What a sad mess that could be. For instance, if an aging parent on Medicare was using O2 and was facing having to decide whether to go into a local nursing home vs being invited to go live with and be cared for by a son or daughter in a different Medicare area.

[Slinky]

AKCPAPGuy, and those on 02 supplementation:

It appears that you are correct as concerns the new guidance from CMS on the 2006 Oxygen rules passed by Congress as part of the Deficit Reduction Act of 2005 by the outgoing Congress. However, in July, 2008, a new Act: H.R. 6331: Medicare Improvements for Patients and Providers Act, has repealed transfer of ownership of oxygen equipment to patients, so you will not own the equipment, and, presumably, cannot bring it with you when you move. H.R. 6331 is summarized here:

http://www.medicareadvocacy.org/Reform_ ... HR6331.htm

Additionally, Medicare will no longer pay for accessories, such as tubing, masks, and cannulas, after the 36 month cap has been reached so you will need to pay for this yourself.

As for snowbirds, or people who move and are away after the 36 month period (and before the 5 year period), your original supplier is supposed to pay for your equipment and maintenance out of pocket, since they will not be reimbursed by Medicare. This is obviously what will NOT happen, so you will be forced to pay out of your own pocket.

I understand that many suppliers in Florida are turning down patient requests for oxygen because of all the confusion.

Medicare's new guidance was released on October 31, and most oxygen suppliers are up in arms, and are hard at work, trying to get these problems worked out during the comment period on the guidance, so we will have to wait awhile until this gets all ironed out. Some of this apparently has come about due to the outgoing administration's HHS Secretary and CMS acting administrator sending a parting shot at Congress due to partisan bickering on both sides.

Here is an excellent article on the new guidance with links on the bottom which include the oxygen rules, Q&A, Summaries, etc.

http://homecaremag.com/oxygen/medicare_ ... tion_1110/

[papdad]

Some people have to have their oxygen tanks refilled with liquid oxygen. Guess I'm lucky in that I use an oxygen concentrator -- if I can just get my tubing to last two to three years. These changes are really, really wrong.
Norm