[Congressional Record Volume 155, Number 139 (Wednesday, September 30, 2009)]
[House]
[Pages H10090-H10092]
From the Congressional Record Online through the Government Publishing Office [www.gpo.gov]




            DELAYING MEDICARE ACCREDITATION REQUIREMENT DATE

  Mr. PALLONE. Mr. Speaker, I move to suspend the rules and pass the 
bill (H.R. 3663) to amend title XVIII of the Social Security Act to 
delay the date on which the accreditation requirement under the 
Medicare Program applies to suppliers of durable medical equipment that 
are pharmacies.
  The Clerk read the title of the bill.
  The text of the bill is as follows:

                               H.R. 3663

       Be it enacted by the Senate and House of Representatives of 
     the United States of America in Congress assembled,

     SECTION 1. EXTENSION OF MEDICARE DME ACCREDITATION DEADLINE 
                   FOR CERTAIN PHARMACIES.

       (a) In General.--Section 1834(a)(20)(F)(i) of the Social 
     Security Act (42 U.S.C. 1395m(a)(20)(F)(i)) is amended by 
     inserting before the semicolon the following: ``, except that 
     the Secretary shall not require under this clause pharmacies 
     to obtain such accreditation before January 1, 2010''.
       (b) Construction.--Nothing in subsection (a) shall be 
     construed as affecting the application of an accreditation 
     requirement for pharmacies to qualify for bidding in a 
     competitive acquisition area under section 1847 of the Social 
     Security Act (42 U.S.C. 1395w-3).

  The SPEAKER pro tempore. Pursuant to the rule, the gentleman from New 
Jersey (Mr. Pallone) and the gentleman from Nebraska (Mr. Terry) each 
will control 20 minutes.
  The Chair recognizes the gentleman from New Jersey.


                             General Leave

  Mr. PALLONE. Mr. Speaker, I ask unanimous consent that all Members 
may have 5 legislative days in which to revise and extend their remarks 
and include extraneous material in the Record.
  The SPEAKER pro tempore. Is there objection to the request of the 
gentleman from New Jersey?
  There was no objection.
  Mr. PALLONE. Mr. Speaker, I yield myself such time as I may consume.
  Presently under Medicare, pharmacies supply Medicare beneficiaries 
with durable medical equipment, or DME, such as canes, crutches and 
diabetes testing strips. Pharmacists not only provide access to these 
items but also provide critical services, such as counseling on patient 
compliance and adherence, which often results in improved health 
outcomes.
  In spite of the important and positive role that many pharmacists 
play in the Medicare DME program, in the past there has been a lot of 
fraud and abuse that has occurred in the world of DME supply. 
Accordingly, Congress stepped in and imposed new requirements on DME 
suppliers that would help rout out fraud, waste and abuse. One of the 
requirements is to require suppliers of durable medical equipment to 
obtain quality accreditation by October 1, 2009, or this Thursday, 
tomorrow.
  Requiring DME suppliers to be accredited would help ensure that the 
integrity of the Medicare program is protected and makes sure that 
beneficiaries have access to quality services and supplies. 
Unfortunately, as pharmacists have tried to comply with this new 
requirement, those charged with providing accreditation have been 
unable to keep up with the demand.
  Accordingly, a backlog of applications now exists, and there is 
little hope of having them completed by this week's deadline. If we do 
nothing, Mr. Speaker, countless pharmacies across the country will be 
left in limbo, possibly causing problems for beneficiaries seeking to 
access the DME supplies that they need. Congress should do everything 
it can to avoid this kind of disruption. The health reform bill 
provides some relief in this area, but its details are still being 
worked out.
  That's why I urge my colleagues on both sides of the aisle to support 
this commonsense measure which will temporarily delay the accreditation 
requirement from taking effect. Congress can fine-tune the health care 
reform legislation to address any remaining problems after January 1, 
which is the new deadline.
  I want to thank my colleague on the Energy and Commerce Committee, 
Mr. Space of Ohio, for spearheading this effort, as well as 
Representatives Jo Ann Emerson, Marion Berry and Jerry Moran.
  I reserve the balance of my time.
  Mr. TERRY. Mr. Speaker, I yield myself as much time as I may consume.
  I rise in support of H.R. 3663, a bill to delay the date for 
accreditation of durable medical equipment suppliers for 90 days. I 
want to thank my colleague from Ohio (Mr. Space) for bringing this 
legislation to the floor today and to correct a provision in the 
Medicare Improvements for Patients and Providers Act of 2008. That law, 
which was approved by the House last year, required suppliers of 
durable medical equipment, DME, to get accreditation before applying to 
the Centers for Medicare & Medicaid Services to meet the quality 
standards before being awarded a contract under the Medicare DMEPOS 
competitive bidding program. The law carved out an exemption for 
certain physicians and other treating practitioners and also gave the 
Secretary of HHS the authority to exempt others.
  By regulation, CMS determined that pharmacists would fall under this 
exemption and not be required to obtain accreditation in order to sell 
durable medical equipment to consumers. Brick and mortar pharmacies, 
however, would be subject to CMS accreditation under the CMS rules.
  The bill would fix this problem and extend the period of time for CMS 
to complete the accreditation process for those pharmacies that have 
filed their paperwork. The bill also includes language clarifying that 
the 90-day extension would not apply to those suppliers wishing to 
participate in competitive bidding for certain durable medical 
equipment.
  The issue that is facing us here today is that only about 43 percent 
of the pharmacies have actually had their inspection and review, 
leaving 50 percent of them out there dangling because of

[[Page H10091]]

the backlog from the inspections. So hopefully within the next 90 days 
from this extension, we'll be able to get caught up, and all of them 
will be able to continue to sell durable medical goods to the patients 
who require such goods.
  Therefore, I encourage all of my colleagues to vote ``yes'' for this. 
Again, I want to thank Mr. Space, Chairman Waxman, Ranking Member 
Barton, and Mr. Pallone for acting so quickly on this when Mr. Space 
and I brought it up last week for attention.
  With that, I reserve the balance of my time.
  Mr. PALLONE. Mr. Speaker, I yield 4 minutes to the gentleman from 
Ohio (Mr. Space), who is the sponsor of this legislation.
  Mr. SPACE. Mr. Speaker, I rise in support of H.R. 3663, legislation 
that I introduced with my friend, Mr. Terry from Nebraska, which will 
delay implementation of accreditation requirements imposed on America's 
pharmacies who offer service to Medicare beneficiaries. I think that my 
colleague from Nebraska as well as my colleague, Chairman Pallone from 
New Jersey, have done an ample job explaining the predicament that we 
find ourselves in with regards to the accreditation and surety bond 
requirements that will be imposed effective tomorrow.
  Certainly, I would like to extend my gratitude to Chairman Waxman, 
Ranking Member Barton, of course Chairman Pallone, and others as well 
for their assistance in providing us with a prompt forum for 
consideration.
  What I would like to do is spend just a moment explaining what the 
implications of failure to act may be on the millions of Medicare 
beneficiaries across the country. Ohio's 18th Congressional District is 
an entirely rural part of the country. Some of our counties, Morgan 
County, Ohio, for example, is served by one pharmacist, one pharmacy in 
the entire county. If that pharmacy, as an example, were to lose its 
ability to provide things like diabetic test strips to its patients, 
those patients would be required to drive up to an hour just to get to 
a pharmacy where they sell those.
  The net effect of that would be that people will not be able to buy 
diabetic test strips, people that need them desperately. One of the 
issues that has been lost in the ongoing debate regarding health care 
reform in this country has been the challenges that rural America faces 
in accessing adequate health care.
  As is the case with so many other issues, whether it be access to 
technology, access to education, access to infrastructure, we in rural 
America suffer from a lack of access to health care. We cannot afford 
to suffer any further, and this legislation will help overcome one of 
those challenges.
  So I urge my colleagues on both sides of the aisle for prompt passage 
today. I think it's also worth noting that this issue is addressed in 
H.R. 3200; but because of this House's intent to thoroughly deliberate 
that legislation, we've not been able to see passage to this point. I 
look forward to working with my colleague from Nebraska and my 
colleagues on both sides of the aisle in resolving this issue promptly.
  Mr. TERRY. I thank the gentleman from Ohio for his kind comments. I 
appreciate it very much, and I enjoyed working with him.
  At this time I yield 4 minutes to the gentleman from Kansas (Mr. 
Moran), one of the co-chairs of the House Pharmacy Caucus.
  Mr. MORAN of Kansas. Mr. Speaker, I thank the gentleman from Nebraska 
and the gentleman from Ohio for this legislation. I am a supporter of 
H.R. 3663. In Kansas and across America, the relationship between 
pharmacists and patients is a vital part of the way we deliver health 
care. Patients depend upon pharmacists for information counseling to 
ensure that they receive quality products and medical services.

                              {time}  1215

  My mom and dad are 92 and 93 and still live in my hometown of 
Plainville, Kansas, a town of about 1,900 people. My dad can be 
stubborn about going to the doctor because the doc may tell him he's 
not 100 percent healthy. But my dad has morning coffee with Keith 
Unrein, our local pharmacist, and Keith keeps a watchful eye on my 
dad's health. Access to pharmacies and other health care services 
determines whether Plainville and other Kansas towns survive and 
flourish, and we must protect and foster these health facilities.
  The Centers for Medicare and Medicaid Services has required 
pharmacies that provide diabetes testing supplies and other medical 
equipment to obtain accreditation by October 1, 2009, in order to 
dispense these important supplies to Medicare patients. H.R. 3663, as 
we have heard, will extend this accreditation deadline to January 1 and 
give Congress the time it needs to better address this issue.
  Many Kansans live in areas with too few doctors and nurses to meet 
their primary care needs. At the same time, the average age of Kansans 
is getting older. Often pharmacists are Kansans' most direct link for 
health information and counseling and the only place for miles that we 
can obtain much-needed medical equipment to keep us healthy.
  However, according to CMS's own estimate, 25,000 medical equipment 
suppliers will exit the Medicare program due to this new accreditation 
requirement. We should be encouraging our pharmacies and other medical 
professionals to provide care to their communities, not burden them 
with cost-prohibitive regulatory requirements that do not increase 
patient safety or expand access for these patients.
  In conclusion, Mr. Speaker, I urge passage of this bill to protect 
Medicare beneficiaries' access to their necessary medications and 
supplies from their trusted pharmacist.
  Mr. TERRY. Mr. Speaker, I yield the balance of my time to the 
gentleman from California (Mr. Herger), member of the Ways and Means 
Committee, and I ask unanimous consent that he be allowed to control 
that time.
  The SPEAKER pro tempore. Is there objection to the request of the 
gentleman from Nebraska?
  There was no objection.
  Mr. HERGER. Mr. Speaker, I yield myself such time as I may consume.
  I rise in support of H.R. 3663, which very simply delays the quality 
accreditation requirements for pharmacies until no sooner than January 
1, 2010. Without this legislation, accreditation requirements would go 
into effect tomorrow and many pharmacies would not be able to supply 
our Medicare beneficiaries with needed, durable medical equipment such 
as diabetes testing strips or canes.
  I've heard from a number of independent pharmacies in my rural 
northern California district who have expressed serious concerns about 
the cost of complying with this new regulation. In many cases, these 
pharmacies are the only source of basic medical supplies for miles 
around and they are already strapped for cash because of reimbursement 
charges at the Federal and State level. Along with many of my 
colleagues on both sides of the aisle, I have taken the position that 
State-regulated pharmacies should be completely exempted from the 
accreditation requirement. At a minimum, I believe all Members can 
support a short delay in the deadline.
  Certain eligible professionals, such as physicians, are exempt from 
the requirement for DME suppliers to be accredited as compliant with 
quality standards. Although pharmacists themselves would be exempt for 
purposes of DME, it's the physical pharmacy that has the Medicare 
provider number, and the Centers for Medicare and Medicaid Services, 
CMS, did not exempt pharmacies from the accreditation requirement.
  Mr. Speaker, we must make it a priority to reduce waste, fraud, and 
abuse in Medicare, and we need strong quality standards for DME 
suppliers. There are simply too many cases of fly-by-night suppliers 
who have defrauded the Medicare program and the taxpayers by submitting 
millions of dollars in fake claims for power wheelchairs and other 
high-end DME.
  However, most pharmacies do very little DME business, mostly 
involving small items like diabetes testing supplies. In addition, 
pharmacies are regulated at the State level, so those that engage in 
questionable activities can be identified and prosecuted. I'm confident 
that the quality accreditation program, with a reasonable exemption for 
pharmacies, will greatly reduce the $1 billion Medicare spent in 2007 
in improper payments for medical equipment and supplies, and I will 
continue to support the program.
  Mr. Speaker, I reserve the balance of my time.

[[Page H10092]]

  Mr. PALLONE. Mr. Speaker, I continue to reserve the balance of my 
time.
  Mr. HERGER. Mr. Speaker, I yield such time as he may consume to the 
gentleman from Georgia, Dr. Price.
  Mr. PRICE of Georgia. I thank my friend from California for leading 
on the issue of health care and for yielding me time.
  Mr. Speaker, as a physician, I have passionately worked, since the 
moment I began in public service and even before then, for positive 
solutions in the area of health care, solutions that allow patients to 
have the highest quality of care. And in debate here on the floor of 
the House especially in the area of health care, Americans are anxious 
for open and honest deliberation and discussion, which is why what 
occurred on the floor last night was so very, very troubling.
  Mr. Speaker, as you may know, Representative Grayson from Florida 
came to the floor for a speech and said that the Republican plan for 
health care is for Americans to, and I quote, ``die quickly.'' In fact, 
he concluded his remarks by saying, ``Remember, the Republican plan: 
Don't get sick. And if you do get sick, die quickly.''
  Mr. Speaker, it's that type of presentation that debases and 
denigrates our proceedings here in the House and it does a disservice 
to all Americans.
  I have a privileged resolution that I'm not going to introduce today, 
but it's a resolution that parallels the previous resolution that was 
handled here in the House, that calls on the House to recognize that 
that kind of behavior is disapproved of by the House of 
Representatives. But in an effort to try to give the Representative 
from Florida, Mr. Grayson, an opportunity to recognize that his 
comments were, in fact, a breach of decorum, we respectfully request 
that he apologize to our leader. And I call on all Democrat Members of 
the House and all Democrat leaders to demand that he apologize, just as 
one of our Members did earlier.
  Mr. Speaker, the American people want open and honest discussion, 
yes, but they want respectful discussion. We call on Mr. Grayson to 
apologize. Mr. Speaker, it's the right thing to do.
  Mr. PALLONE. Mr. Speaker, I continue to reserve the balance of my 
time.
  Mr. HERGER. Mr. Speaker, this is a good, commonsense bill with broad 
support from both Democrats and Republicans. This is an example of the 
way that health care policy should be handled in this Congress. I urge 
an ``aye'' vote.
  Mr. Speaker, I have no further requests for time, and I yield back 
the balance of my time.
  Mr. PALLONE. Mr. Speaker, in closing, I just want to mention that my 
colleague Mr. Stark, from the Ways and Means Committee, wanted to speak 
in favor of this bill but was unable to be here. I also neglected to 
thank Mr. Terry, who was the lead Republican sponsor of the 
legislation.
  I urge passage of the bill.
  Mr. POMEROY. Mr. Speaker, I rise in support of H.R. 3663, bipartisan 
legislation that I introduced with Congressmen Zach Space (D-OH) and 
Lee Terry (R-NE) which will delay implementation of flawed 
accreditation requirements imposed on America's pharmacies who offer 
service to Medicare beneficiaries.
  Starting tomorrow pharmacies will be required to meet new 
accreditation requirements in order to participate in Medicare's 
Durable Medical Equipment Prosthetics, Orthotics and Supplies (DMEPOS) 
program. This program ensures that seniors covered under Medicare have 
access to critical medical supplies and Part B medications.
  I have heard first hand from pharmacists across my state of North 
Dakota about the negative impact saddling these new costly and 
burdensome accreditation requirements will have on seniors' access to 
supplies and medications that pharmacists provide, especially diabetes 
testing strips. These local pharmacists have been faced with the tough 
choice of spending thousands of dollars they do not have to fulfill 
these accreditation requirements or leave seniors will no affordable 
access to the critical supplies and medications they need.
  Both the House and Senate have included in their health care reform 
proposals important changes to these flawed regulations that will 
protect seniors' access to their medications and supplies. However, we 
have not yet been able to complete consideration of this legislation 
before the October 1st effective date.
  By enacting H.R. 3663, which provides a three month extension of the 
DMEPOS accreditation requirement date for pharmacies, we will be 
providing Congress the additional time it needs to reform these 
important rules. Doing so will enable seniors to continue receiving 
valuable health care products at community pharmacies without 
disruption.
  H.R. 3663 is important legislation that will protect America's 
Medicare beneficiaries. Leadership did the right thing bringing this 
important legislation to the House floor and I urge my colleagues to 
support it.
  Mr. PALLONE. Mr. Speaker, I yield back the balance of my time.
  The SPEAKER pro tempore. The question is on the motion offered by the 
gentleman from New Jersey (Mr. Pallone) that the House suspend the 
rules and pass the bill, H.R. 3663.
  The question was taken; and (two-thirds being in the affirmative) the 
rules were suspended and the bill was passed.
  A motion to reconsider was laid on the table.

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