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 1999-04-05 monographic deposited born digital 28 p. GA 1.13:HEHS-99-56 https://www.govinfo.gov/app/details/GAOREPORTS-HEHS-99-56 P0b002ee1803a0eb4 f:he99056 DGPO 2010-08-12 2011-03-23 GAOREPORTS-HEHS-99-56 machine generated eng fdlp REPORT GAOREPORTS-HEHS-99-56 HEHS-99-56 Medical services rates Health care cost control Medical supplies Health care programs Medical equipment Respiratory diseases Medicare Program Letter Report HEHS

Pursuant to a legislative requirement, GAO provided information on Medicare beneficiaries' access to home oxygen equipment, focusing on: (1) changes in access to home oxygen for Medicare patients since the payment reduction mandated by the Balanced Budget Act (BBA) of 1997 took effect; and (2) actions taken by the Health Care Financing Administration (HCFA) to fulfill the BBA requirements and respond to GAO's November 1997 recommendations.<p/>GAO noted that: (1) preliminary indications are that access to home oxygen equipment remains substantially unchanged, despite the 25-percent reduction in Medicare payment rates that took effect in January 1998; (2) the number of Medicare beneficiaries using home oxygen equipment has been increasing steadily since 1996, and this trend appears to have continued in 1998; (3) while Medicare claims for the first 6 months of 1998 showed a decrease in the proportion of Medicare patients using the more costly stationary liquid oxygen systems, this decline was consistent with the trend since 1995; (4) hospital discharge planners and suppliers GAO talked with said that even Medicare beneficiaries who are expensive or difficult to serve are able to get the appropriate systems for their needs; (5) further, suppliers accepted the Medicare allowance as full payment for over 99 percent of the Medicare home oxygen claims filed for the first half of 1998; (6) although these indicators do not reveal access problems caused by the payment reductions, issues such as sufficiency of portable tank refills and equipment maintenance could still arise; (7) HCFA has responded to only one BBA requirement; (8) as required by the BBA, HCFA has contracted with a peer review organization (PRO) for an evaluation of access to, and quality of, home oxygen equipment; (9) results from this evaluation are not expected before 2000; (10) meanwhile, HCFA has not implemented an interim process to monitor changes in access for Medicare beneficiaries--a process that could alert the agency to problems as they arise; (11) although not required by the BBA, such monitoring is important because of the life-sustaining nature of the home oxygen benefit; (12) until HCFA gathers more in-depth information on access and the impact of payment reductions, HCFA cannot assess the need to restructure the modality-neutral payment; (13) HCFA has not yet implemented provisions of the BBA that require service standards for Medicare home oxygen suppliers to be established as soon as practicable; and (14) service standards would define what Medicare is paying for in the home oxygen benefit and what beneficiaries should expect from suppliers. https://www.govinfo.gov/content/pkg/GAOREPORTS-HEHS-99-56/html/GAOREPORTS-HEHS-99-56.htm https://www.govinfo.gov/content/pkg/GAOREPORTS-HEHS-99-56/pdf/GAOREPORTS-HEHS-99-56.pdf GAO/HEHS-99-56 https://www.govinfo.gov/app/details/GAOREPORTS-HEHS-99-56 Letter Report GAO/HEHS-99-56; Medicare: Access to Home Oxygen Largely Unchanged; Closer HCFA Monitoring Needed; Medical services rates Health care cost control Medical supplies Health care programs Medical equipment Respiratory diseases Medicare Program Title 42 Section 1395w-3 42 U.S.C. 1395w-3 Public Law 105-33