Medicare Clarifies DME Exemption as Deadline Looms

CMS addressed confusion about provisions in the new health care law that govern pharmacies' ability to sell durable medical equipment.

Among the many components of the Patient Protection and Affordable Care Act that have yet to be implemented, one provision that will substantially impact pharmacy practice is just around the corner. Beginning January 1, 2011, all pharmacies that sell durable medical equipment, prosthetics, orthotics, and supplies (DMEPOS) must meet Medicare’s accreditation requirements or qualify for exemption.

In a conference call held in October, the Centers for Medicare & Medicaid Services (CMS) clarified which pharmacies meet the requirements for exemption under the new law. Writing on behalf of the American Pharmacists Association, Diana Yap reviewed the criteria, as outlined by CMS official Sandra Bastinelli, senior technical advisor for the agency’s Center for Program Integrity.

In order to qualify for exemption, a pharmacy must have:

• DMEPOS sales of less than 5% of total sales for the past 3 years;

• been enrolled in DMEPOS, with a valid provider number, for at least 5 years;

• not had any federal adverse action filed against it for the past 5 years.

In the case of chain pharmacies—defined as having 25 or more locations—the criteria will be applied to individual branches. New pharmacy locations and those that have changed ownership over the past 5 years do not qualify for exemption, Yap noted.

In October, the National Supplier Clearinghouse (NSC) sent letters to qualifying pharmacies, which have 30 days to respond and confirm that they meet all 3 criteria. Beginning in 2011, NSC will randomly audit 10% of exempt pharmacies to verify that they meet the requirements.

Those who did not receive a letter but feel they may qualify for exemption should keep tabs on the NSC Web site, where a copy of the letter is expected to be available for download in November. Pharmacists with further questions about the nuts and bolts of the new accreditation and exemption requirements can consult the full transcript and audio recording of the session, which will be available until November 22, 2010.

For other articles in this issue, see:

  • Record Drug Shortages Prompt Emergency Action
  • Bending the Rules to Improve Patient Care