United States Government Publishing Office publisher pbl distributor dst United States Government Accountability Office Health, Education, and Human Services Division author aut Government Organization text government publication eng GAOREPORTS Legislative Agency Publications gao legislative 2010-08-12 U.S. Government Printing Office 1997-11-07 monographic deposited born digital 28 p. GA 1.13:HEHS-98-17 https://www.govinfo.gov/app/details/GAOREPORTS-HEHS-98-17 P0b002ee1803864e2 f:he98017 DGPO 2010-08-12 2011-03-28 GAOREPORTS-HEHS-98-17 machine generated eng fdlp REPORT GAOREPORTS-HEHS-98-17 HEHS-98-17 Home health care services Health care cost control Medical supplies Health care programs Respiratory diseases Quality assurance Veterans benefits Medical services rates Comparative analysis Medical equipment Medicare Program Other Written Product HEHS 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.<p/>GAO noted that: (1) Medicare's fee schedule allowances for home oxygen exceeded GAO's adjusted estimate for the competitive marketplace rates paid by VA by almost 38 percent; (2) the rate reductions mandated by the Balanced Budget Act of 1997 will bring Medicare's fee schedule more into line with the competitive marketplace costs for home oxygen; (3) concerns have been raised that these reductions could reduce Medicare beneficiaries' access to portable units; (4) under Medicare's modality-neutral payment system, home-based liquid oxygen systems, which patients can use to refill portable units, do not offer suppliers the attractive profit margins associated with lower-cost oxygen concentrators; (5) lightweight, less cumbersome portable systems, which may increase patient mobility, are more expensive than traditional portable gas cylinders; (6) GAO's analysis shows that VA patients were receiving more portable units and refills than Medicare patients were, even though VA's payment rate, adjusted for comparability, was lower than Medicare's; (7) the upcoming reductions in Medicare allowances may lead some suppliers to provide Medicare patients with the least costly systems available, regardless of their patients' needs; (8) the Department of Health and Human Services (HHS) could use its authority under the recently enacted legislation to establish separate reimbursement rates for oxygen concentrators, liquid systems, regular portable units, and lightweight portable units, as long as the impact on overall Medicare costs is budget neutral; (9) the evolution in technology and costs of oxygen delivery systems--and the clinical indications for initiating and terminating the use of more expensive, lightweight portable units--warrant further examination by HHS and the Health Care Financing Administration (HCFA) before deciding whether Medicare's reimbursement system should be restructured; (10) HCFA has not established standards to ensure that home oxygen suppliers provide Medicare patients even basic support services; (11) oxygen suppliers who serve Medicare patients need only comply with basic registration and business requirements associated with obtaining a Medicare supplier number; (12) in contrast, VA encourages its medical centers to contract with suppliers who are accredited by the Joint Commission on Accreditation of Healthcare Organizations or comply with its standards; (13) VA patients typically received more frequent service visits than Medicare patients; and (14) the Balanced Budget Act requires HHS to establish service standards for Medicare home oxygen suppliers. https://www.govinfo.gov/content/pkg/GAOREPORTS-HEHS-98-17/html/GAOREPORTS-HEHS-98-17.htm https://www.govinfo.gov/content/pkg/GAOREPORTS-HEHS-98-17/pdf/GAOREPORTS-HEHS-98-17.pdf GAO/HEHS-98-17 https://www.govinfo.gov/app/details/GAOREPORTS-HEHS-98-17 Other Written Product GAO/HEHS-98-17; Medicare: Home Oxygen Program Warrants Continued HCFA Attention; Home health care services Health care cost control Medical supplies Health care programs Respiratory diseases Quality assurance Veterans benefits Medical services rates Comparative analysis Medical equipment Medicare Program Public Law 105-33