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Friday, September 29, 2017   (0 Comments)
Posted by: Becky Carroll
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The WOCN® Society In Action is a members-only public policy and advocacy newsletter that is published four times a year to highlight the most pressing issues related to WOC health care and the Society's advocacy efforts.
Lymphedema Treatment Act

The Lymphedema Treatment Act continues to add cosponsors in the 115th Congress. The legislation (H.R. 930 / S. 497) would amend Medicare statute to pay for compression garments, bandages and supplies to reduce lymphedema-related swelling and prevent recurrence. Since being introduced in February, the bill has added 277 cosponsors in the House and 34 cosponsors in the Senate.
 
As you well know, compression therapy is considered the gold standard for the treatment of lymphedema and the treatment and prevention of venous leg ulcers (VLUs), also known as stasis ulcers. The WOCN Society strongly supports the Lymphedema Treatment Act, as this legislation reflects the vision and core tenets of the Society as a means to support cost-effective, evidence-based prevention and treatment of complex wound conditions such as VLUs and lymphedema. The Society has prepared a white paper on Medicare coverage of compression therapy.
 
While the number of cosponsors is impressive, we need more to ensure this legislation passes Congress. YOU CAN HELP. Please send your members of Congress a message urging support for the Lymphedema Treatment Act. Follow this link to send your message and make your voice heard.
Medicare Competitive Bidding

As you may recall, President Obama released his proposed FY 17 budget in March 2016, a provision to expand Medicare's Competitive Bidding (CB) program to new product categories. The budget proposed that inhalation drugs; all prosthetic and orthotics; and ostomy, tracheostomy and urological supplies all be listed as products subjected to competitive bidding. The Society has expressed serious concerns with this proposal, as ostomy supplies and urological supplies are not well-suited for a competitively bid program because of their highly customizable nature. The Society has fought to exclude these products from the program in the past and will continue to do so in the future.

The Society is hopeful that the new administration will not continue to pursue the expansion of the CB program in the future. In response to the flawed policy approach, the Society's leadership has developed an advocacy action plan to keep ostomy products excluded from Competitive Bidding. 
To date, the Trump Administration has not moved forward with expanding the CB program to include ostomy supplies. In fact, CMS has now delayed the latest round of new CB programs for 2019. The 2019 expansion would have included CPAP devices and insulin pumps. In a statement CMS explained, "CMS has decided to temporarily delay moving forward with the next steps of the Round 2019 DMEPOS Competitive Bidding Program to allow the new administration further opportunity to review the program." The Society will continue to monitor the CB program and keep members informed.
 
WOCN Supports Legislation to Reform Local Coverage Determinations
 
Legislation has been introduced in Congress to reform how Medicare Administrative Contractors (MACs) determine how they will pay for services. MACs are private entities contracted by Medicare to process claims and make reimbursement decisions on medical items and services. There are 12 MACs for Medicare's hospital and office based services providing Medicare coverage across the country. In recent years, MACs have shown a pattern of making coverage decisions that are void of current practice methodology, lack provider input, and are not in the best interest of patient care.
 
S.794, the Local Coverage Determination Clarification Act of 2017 introduced by introduced by Sens. Johnny Isakson (R-Ga.), Tom Carper (D-Del.), Debbie Stabenow (D-Mich.), and John Boozman (R-Ariz.), would help restore balance to the LCD process by making the following changes:

1. Open Meetings: Requires that Medicare Administrative Contractors' (MACs) Carrier Advisory Committee (CAC) meetings be open, public, and on the record. Minutes taken and posted to the MAC's website for public inspection. Requiring these increased levels of transparency will facilitate an improved forum for information exchange between MACs and interested parties.

2. Upfront Disclosure: Requiring MACs to include - at the outset of the process - a description of the evidence the MAC considered when drafting an LCD, as well as the rationale they are relying on to deny coverage.

3. Meaningful Reconsideration and Options for Appeal: Creating an appeals process for providers and suppliers to appeal a MAC's decision to CMS. Under current Centers for Medicare & Medicaid Services (CMS) rules, MAC LCDs are essentially unreviewable once they become final. S.794 gives providers and suppliers an opportunity to have a qualified third party make a decision about the validity of their reconsideration requests in limited circumstances.

4. Stopping the Use of LCDs as a Backdoor to NCDs: Prohibiting CMS from appointing a single MAC, either expressly or in practice, from making determinations to be used on a nationwide basis in a given specialty. The CAP has witnessed the carbon copy adoption of LCDs by other MACs without the benefit of meaningful solicitation or independent assessment of comments and concerns from the public or medical community of the adopting MAC. This has the practical effect of establishing national coverage policies without having followed the more rigorous national coverage determination (NCD) requirements.

5. Creating an Ombudsman: Creating an Ombudsman to provide providers and suppliers with administrative and technical assistance in filling appeals, make publicly available information about the number of appeals filed with the MAC and with CMS each year, the actions taken by the MACs with respect to appeals filed, the number of times the Secretary took action in response to appeals filed with HHS, responsiveness of the MACs, and providing recommendations to the Secretary on ways to improve the efficiency of the appeals process.
 
The Society has become very concerned about how these LCDs will impact patient care in the future and have endorsed S. 794. Our letter of support can be found here. The Society recently submitted comments to two contractors (First Coast Option & Novitas Solutions) who have proposed concerning changes to wound care policies in separate LCDs.

The Society provided comments directly to the changes available here: First Coast Option & Novitas Solutions, as well as participated in developing comments through the Alliance of Wound Care Stakeholders.
WOCN Supports Legislation to Allow NPs to Order Home Health Services

A quirk in Medicare law has kept APRNs from signing home health plans of care and from certifying Medicare patients for the home health benefit. The Home Health Care Planning Improvement Act of 2017 (S. 445/H.R. 1825) would correct this quirk and allow NP's to order home health. Medicare has recognized the autonomous practice of these APRNs for nearly two decades, as they provide the majority of skilled care for home health patients. While these health care professionals are authorized to perform face-to-face assessments of a patient's needs, a physician must certify the assessment.

The WOCN Society has endorsed this legislation and encourages you to contact your members of Congress and ask that they support The Home Health Care Planning Improvement Act of 2017.
Society Urges Congress to Maintain Funding for Federal Nursing Workforce Programs
 
On July 18th, the WOCN Society joined with the Nursing Community and sent a letter to Congress urging them to fully fund federal nursing workforce programs. You may recall that the President's budget proposal recommended to Congress that health professions and nursing workforce programs (Title VIII Nursing Workforce) be cut by $403 million dollars and the National Institutes of Health be cut by $5.8 billion (20%).
 
The letter urges the House Appropriations Committee to maintain essential funding for all Nursing Workforce Development programs (Title VIII of the Public Health Service Act) as they consider the fiscal year (FY) 2018 Labor, Health and Human Services, and Education Appropriations (LHHS-ED) bill. So far, Congress has not shown an interest in accepting the President's recommendation to eliminate nursing workforce programs.
Troubling Changes to Surgical Dressing Coverage Finalized

You may recall, back in August of 2015, CMS assigned the Durable Medical Equipment Medicare Administrative Contractors (DME MACs) the task of developing local coverage determinations (LCDs) for processing and reviewing Medicare claims for Surgical Dressings under the Durable Medical Equipment, Prostheses, Orthoses, and Supplies (DMEPOS) program. The changes contained in the proposed LCD policy and related policy article would substantially impact coverage for a variety of surgical dressings.

After reviewing the LCD draft policy, the WOCN Society had significant concerns about the proposal and strongly suggested that this draft be withdrawn and that CMS work with stakeholders to create a more clinically-appropriate document. The Society's comments, which were submitted to the DME MACs, can be found here.

Unfortunately, CMS approved a final version of the dressings coverage policy, which included no changes from the draft and included none of the recommendations suggested by the Society. The Society will be reaching out to CMS and other stakeholders to blunt the impact of these changes on patients.
If you have questions regarding any of these issues, please contact:

Chris Rorick, MPH
Director of Government Relations
chris.rorick@bryancave.com
+1 202-508-6354
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