Medicare: Home Oxygen Program Warrants Continued HCFA Attention
HEHS-98-17
Published: Nov 07, 1997. Publicly Released: Nov 13, 1997.
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Highlights
Pursuant to a congressional request, GAO reviewed the appropriateness of Medicare's reimbursement rates for home oxygen, focusing on: (1) its comparison of Medicare and Department of Veterans' Affairs (VA) payment rates; (2) concerns about access to liquid oxygen systems and lightweight portable equipment for patients who are highly active; and (3) standards for the services associated with meeting patients' home oxygen needs.
Recommendations
Recommendations for Executive Action
| Agency Affected | Recommendation | Status |
|---|---|---|
| Health Care Financing Administration | The Administrator of HCFA should monitor trends in Medicare beneficiaries' use of and access to stationary liquid oxygen systems and liquid and gas portables. |
CMS, through a contractor, has conducted a long range study to monitor beneficiaries' use of, and access to, stationary liquid oxygen systems and gas portables. CMS has also studied access issues related to two competitive bidding projects that include oxygen. Both of these undertakings show that access to oxygen has not been negatively affected, and is not an issue of concern.
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| Health Care Financing Administration | The Administrator of HCFA should monitor the availability and costs of new and evolving oxygen delivery systems, including lightweight portable systems and oxygen conserving devices, and work with the medical community to: (1) evaluate the clinical benefits associated with the use of such equipment; (2) identify the patient populations most likely to benefit from the use of such equipment; and (3) educate prescribing physicians about existing options in oxygen delivery systems and their right to prescribe the system that best meets their patients' needs. |
CMS, through a contractor, has conducted a long range study to monitor beneficiaries' use of, and access to, stationary liquid oxygen systems and gas portables. In 2001, CMS' provider education staff will work with its policy component to develop an appropriate education campaign. CMS has not reported any further action since 2002.
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| Health Care Financing Administration | The Administrator of HCFA should advise the Secretary of HHS whether a budget-neutral restructuring of the Medicare reimbursement system for home oxygen is needed to provide patient access to the more expensive home oxygen systems, and whether Medicare controls can be implemented to ensure that the use of such systems is limited to patients that can benefit from their use. |
CMS, through a PRO contractor, has conducted a long range study to monitor beneficiaries' use of, and access to, stationary liquid oxygen systems and gas portables. Based on the PRO study, CMS has decided that no restructuring of the payment system is needed.
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| Health Care Financing Administration | The Administrator of HCFA should work with the medical community, the oxygen industry, patient advocacy groups, accreditation organizations, and VA officials to promptly finalize service standards for Medicare home oxygen suppliers. |
In August 2006, CMS published quality standards for suppliers of home oxygen and other durable medical equipment, prosthetics, orthotics, and supplies. These standards, among other things, require home oxygen suppliers to provide respiratory services 24 hours a day, 7 days a week as needed by the beneficiary and follow delivery and set-up practice guidelines established by the American Association for Respiratory Care.
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Topics
Comparative analysisHealth care cost controlHealth care programsHome health care servicesMedical equipmentMedical services ratesMedical suppliesMedicareQuality assuranceRespiratory diseasesVeterans benefitsOxygen