Joan L. Headley, Executive Director
Gazette International Networking Institute
(GINI)
coordinator of the International Polio Network
and the International Ventilator Users Network
4207 Lindell Boulevard #110
Saint Louis, MO (Missouri) 63108-2915 USA
314/534-0475 314/534-5070 fax
gini_intl(AT)msn.com
www.post-polio.org
-----Original Message-----
From: GINI <gini_intl(AT)email.msn.com>
To: Bob Mauro - PeopleNet <mauro(AT)idt.net>
Date: Monday, May 11, 1998 4:40 PM
Subject: backup equipment
>Dear Bob:
>The information Representative Carolyn McCarthy has unearthed is the same
we
>found. I am mailing a copy of a definition and description of "Backup
>Equipment" from Region D of the Health Care Financing Administration
(HCFA).
>(It would be safe to assume that each region has a copy). It
substantiates,
>in essence, what you wrote in your most recent e-mail.
>Please note there is a difference between backup equipment and multiple
>medically necessary items- which are defined as "identical or similar
>devices, each of which meets a different medical need for the patient."
The
>definition further states that Medicare will make separate payment for a
>second piece of equipment if required to serve a different purpose. This
is
>why McCarthy recommended that the physician rewrite the letter stating that
>you needed it for another purpose -in your case, mobility. You have need
of
>multiple items not a backup.
>Backup equipment is defined as "an identical or similar device that is used
>to meet the same medical need for the patient but is provided for
>precautionary reasons to deal with an emergency in which the primary piece
>of equipment malfunctions." The statement specifically state that Medicare
>will not pay separately or make an additional payment for backup equipment.
>The sheet I am mailing goes on to explain why Medicare does not pay more
for
>a backup. Ventilators are in a category called "frequent and substantial
>servicing payment category." Ventilators and an infusion pump are the only
>two items in this category (if the information I received is correct, the
>pumps will be taken off this list soon). Any way, what this category means
>(to HCFA) is that that the fee paid to the supplier/home care companies is
>so substantial (a large monthly fee) it is the responsibility of the
>supplier to provide an acceptable contingency plan (it could be a backup or
>frequent service calls) to address emergencies including mechanical failure
>without additional payment from Medicare.
>So Medicare is saying the cost of a backup ventilator (as defined above) is
>the responsibility of the supplier.
>Does this help? Their position will be more clear once you receive the
>complete definition which I mailed today.
>Joan
>
>Gazette International Networking Institute
>(GINI)
>coordinator of the International Polio Network
>and the International Ventilator Users Network
>4207 Lindell Boulevard #110
>Saint Louis, MO (Missouri) 63108-2915 USA
>314/534-0475 314/534-5070 fax
>gini_intl(AT)msn.com
>www.post-polio.org
>
>