1. Mandatory Accreditation is Here: Now What? AARC 52 nd International Respiratory Congress Bob Floro, RRT Senior Associate Director Joint Commission December 13, 2006

2. Topics for Today MMA and Mandatory Accreditation Value of Accreditation

3. Two MMA Requirements for Accreditation 1. All DMEPOS Suppliers Must meet CMS Quality Standards - Unsure of Implementation Date 2. To Participate in Competitive Bidding – Implementation to Begin in 2007

4. CMS Recognition of Accreditors Must Meet Quality Standards Through Accreditation Process Final CMS Quality Standards released August 2006 Accreditor Must Be Recognized by CMS – Eleven chosen by CMS – Some accreditors have limited scope

5. 8/1/06 CMS Fact Sheet Requirements of Accreditors Plan for small business – Plan to reduce accreditation fees for small/specialty suppliers and suppliers that have multiple locations. Application of streamlined quality standards – Processes will not to expand on streamlined quality standards. Streamlined processes – Their role is to ensure compliance with the quality standards. Exclude certain services - Accreditation should not be contingent on using consultation services or purchasing manuals. Unannounced survey process – Utilizing an unannounced survey process reduces “ramp-up” costs and survey preparation time.

6. Same Process as Today Value of accreditation should not change CMS Quality Standards woven into the fabric of accreditation Elements of survey process examines patient services Accreditation assures patient safety and quality of services

7. What’s known today: Competitive Bidding Must be accredited to receive a contract award CMS to begin paying Q4 2007 CMS determines payment amount based on bids Awards cannot exceed current fee schedule

8. Implementation Schedule and MSA’s 2007 – 10 MSA’s 2009 – 80 MSA’s Chicago, New York and Los Angeles excluded from 2007 competitive bidding Specific equipment categories will be bid Eleven Accreditors Recognized by CMS What’s known today: Competitive Bidding (cont.)

9. HR 3559 - Hobson-Tanner Bill (7/28/05) Proposes Changes in Competitive Bidding Supports Quality Standards and Accreditation 150+ co-sponsors Exempts rural areas (MSA’s under 500,000) Allows all qualified suppliers to participate in CB Adds judicial review for providers Exempts items and services if 10% savings cannot be achieved Companion Senate Bill: – Introduced 9/21/06 - S 3920 Hatch – Conrad Bill

10. The Eleven All Services: Joint Commission CHAP ACHC CARF HQAA BOC – Board for Orthotist/Prosthetist Certification ABC – Am. Bd. For certification in O & P National Board For Accreditation for Orthotic Suppliers National Association for Boards of Pharmacy Board of Certification in Pedorthics Compliance Team

11. Values of A Quality Accreditor Standards are Relevant and Address Quality and Patient Safety Processes are Developed Using Resources From The Industries It Serves A Patient Focused Survey Process Accreditation Decisions Are Consistent Effective Surveyor Training, Education and Qualifications Survey Includes Education And Consultation Continuous Process – 100%/100% Experience, Resources and Ability to Sustain

12. What We Don’t Know Today Equipment Categories to Be Bid – Some Suspects: Oxygen, Diabetic Equipment and Supplies, Wheelchairs and Orthotics/Prosthetics

13. 10 MSA’s – Some suspects: Houston, Riverside CA, VA Beach, St. Louis, Kansas City, San Juan, Atlanta, Charlotte, Miami and Pittsburgh Rules for Competitive Bidding (MSA’s and Equipment - to be announced before end of 2006 What We Don’t Know Today (cont.)

14. CMS Quality Standards Business Standards – Administration, Financial Management, Human Resource Management, Customer Services, Performance Management, Product Safety, and Information Management General Product-Specific Service Standards – Preparation, Delivery and Setup, Training/Instruction to Beneficiary and Caregiver, and Follow-up Appendix A – Respiratory Equipment and Supplies – AARC CPG’s – Delivery/Setup and Patient/Caregiver Instruction Appendix B – Standard and Custom Mobility – Factory Trained Technician and RTS for Custom Mobility Appendix C – Custom O & P – Proscriptive Assessment Requirements – Plans of Care

15. Value of Accreditation

16. The Value of Accreditation Improves Quality Of Care Improves Patient Safety Raises Awareness Of Compliance Issues Raises Awareness Of Liability Issues Represents HME Company To The Public As A Quality Organization Improved Access To Referral Sources Meets Some State License Requirements Access To Third Party Payors Access to CMS Beneficiaries

17. Improves the Quality of Care and Services Meeting Standards and Requirements Survey Process – External Validation Through Commitment to Quality and Organizational Culture

18. Improves Patient Safety Improve Processes Standards Compliance Performance Improvement Culture

19. Compliance and Liability Standards Address Regulatory Agency Requirements Standards Address Law and Regulation Examples of Standards that Address Liability – Patient Rights and Responsibilities – Organizational Ethics and Billing Practices – Leadership – Responsibility and Accountability – Environment of Care - Operable Equipment, Safe Vehicles, Effective PM/Maintenance, Backup Services and Equipment, etc. – Management of Information and Documentation Potential Decrease In Liability Costs

20. State and Federal Recognition State Recognition of Accreditation – DME Licensure Requirements – Growth Post MMA CMS – Validation of Patient Safety and Quality Services – Validation of Ethical Practices

21. Access to Third Party Payors Private Carriers – Traditional and MCO State Medicaid Programs – Current Trend – Growth Post MMA CMS – Payment for Quality, Patient Safety, Beneficiary Access and Ethical Practices

22. Elements of Accreditation Application Preparation On-Site Survey Accreditation Decision Post-Survey Activities Interim Activities

23. Elements of the On-Site Survey Unannounced! Opening conference Patient Visits Documentation Review Review of Environments – Warehouse, trucks, patient environment, emergency preparedness, etc. Employee Competency Review Leadership Review Summary Conference

24. Value Accreditation must bring value to: – Individual organizations – Patient Safety – Quality of Patient Services – The Industry Raise the Bar!

25. Contacts Joint Commission: – Home Care 630-792-5771 – Bob Floro 630-792-5741 rfloro@jointcommission.org CMS – DMEPOS Center: http://www.cms.hhs.gov/center/dme.asp – Accreditor List: