The face of Medicare has changed drastically over the years, but no more so than with the passage and implementation of the Medicare Modernization Act of 2003 (MMA). This legislation not only reduced Medicare reimbursement to those companies providing services, equipment and supplies (SES) to Medicare Part B beneficiaries, but also changed the rules pertaining to who will be responsible for future SES reimbursement. Unfortunately, Medicare Part B providers are all too familiar with reimbursement restrictions. Congress and CMS have reduced reimbursement for Durable Medical Equipment (DME) almost every year for the past 15 years. While business costs have risen, reimbursement has fallen. Imagine the average family surviving on 1992 wages in 2007. And to make matters worse, as reimbursement has been cut, the Medicare Part B providers have been tasked with additional bureaucratic requirements that raise costs. In an effort to save money, Congress and CMS have reclassified some SES. They have also shifted the burden of payment for some SES from Medicare to the beneficiary. The main SES affected by these changes is medical oxygen. Medical oxygen has always been considered a “frequently serviced” item with life-sustaining ramifications. However, the MMA stripped Medical Oxygen of its life-sustaining label and it was reclassified as a “capped item” requiring no more servicing than that of a wheelchair or hospital bed. This reclassification is at odds with reality. Oxygen equipment requires periodic inspection and maintenance as mandated by the manufacturer of the equipment. Medicare Part B providers understand this and schedule the equipment to be “frequently serviced” per the manufacturer guidelines. This servicing has always been included in the reimbursement for the equipment and is not an add-on-cost. Under MMA, Medicare pays for the home oxygen equipment for 36 consecutive months and the Medicare Part B provider maintains ownership of the equipment during this time, performing all required inspections and maintenances. However, at the end of the 36th month, ownership of the equipment is transferred to the beneficiary and Medicare makes no further payments on oxygen SES. From this point on, all responsibility for inspection and maintenance, as well as reimbursement for such services, falls on the beneficiary’s shoulders. This creates a potentially unsafe situation. Will the typical beneficiary remember to schedule needed maintenance? Will some beneficiaries postpone maintenance services in order to save money? This is not in the best interests of patients who need continuous functioning of their oxygen equipment. Congress continues to try to balance the budget on the backs of the poor, the sick and the elderly. The most vulnerable and the least capable in our society continue to be targeted. Real Medicare reform must start by making some basic changes, but this is not the way. I have some ideas on reforming Medicare and a plan to make it solvent, but that will come in later articles. Right now we need to restore oxygen SES to that which was in place prior to the MMA of 2003. Call and write your Congressperson and tell him to co-sponsor and vote for HR621. Joe Bryant is the owner of Happy Home Health, a Birmingham based durable medical equipment provider. January 2008