The holidays are always a wonderful time of year for family gatherings, reflection on what we have and the spirit of giving. The television is packed with specials showing relationships and families coming together for the holidays.

There are many decisions to be made when imminent death is approaching for a loved one. Questions regarding what type of care, medical assistance and even physical location for their last days confront us.

Federal law dictates that no one may help a veteran in the preparation, presentation and prosecution of an initial claim for VA benefits unless that person is accredited. The only exception to this law is that any one person can help any veteran -- one-time only -- with a claim. To help any veteran a second time requires accreditation.

Experts say that over a million people in the United States have chronic obstructive pulmonary disease (COPD). It is a chronic lung condition that includes bronchitis, emphysema or both.

Rural Development makes loans for repairs to improve or modernize a home for families and individuals with very low incomes. These improvements are intended to make it safer or more sanitary, and/or even to remove health hazards. For seniors 62 and older who cannot afford a loan, grant funds many be available for these necessary repairs.

October is National Residents' Rights Month, a national effort to celebrate, honor, educate, and protect those living in long-term care homes and their families. The goal is to help not only the residents themselves but their families and communities recognize the rights of long-term care residents and learn how to speak up if they or someone they love are not receiving these rights.

James A. Froude said, "We enter the world alone, we leave the world alone." There is no feeling more horrible than the loneliness one feels in the unsettling quiet of an empty house. For many elderly, it seems that aging accompanies loneliness as children leave and spouses pass on. Though many children devote years of their lives to care for their elderly parents, others abandon them to solitude.

The United States is experiencing a remarkable increase in the number of people who live to an old age. Our older population (people 65 years or older) numbered nearly 40 million in 2009 (latest year of available data). These folks represent one in every eight Americans, or 13% of the population. By 2030, it is projected that the U.S will be home to more than 72 million people age 65 and older.

You've heard people say it and maybe you have even said it yourself. "Don’t worry Mom or Dad, I’ll take care of you in your old age."

Our council is dedicated to helping families recognize the need for long term care planning and to help implement that planning. All elderly people, regardless of current health, should plan for the myriad of financial events and challenges they might face. Social Security retirement benefits alone will not adequately help us meet these challenges; however, the program itself, how it is funded, and how the payouts work must be understood by every retiree.

According to Department of Veterans Affairs census estimates, there are approximately 13 million veterans and their single surviving spouses age 65 and older. Comparing this to a total of 41 million Americans 65 and older, veterans and their single surviving spouses represent about 1/3 of the senior population. According to VA about 42% of all veterans are 65 and older. This percentage will continue to grow as the bulk of the Vietnam veterans - the largest cohort - are still younger than age 65.

Seniors are the fastest growing segment of the population, not only in the United States, but in the world. Currently, individuals age 65 and over represent 13% of the U. S. population – about 41 million people– but this will grow to 20% -- 88 million -- in just a matter of 38 years. Seniors also control a great deal of the wealth in this country.

At some point in our lives we may ask ourselves: If I die and have debt, who or what will be responsible for paying back those I owe?

They live in your city, perhaps on your street or even next door. They serve with courage, perseverance, patience and love. Some give 24 hours a day, with days blending into weeks, months and years. They are family caregivers; heroes quietly caring for loved ones at home.

If we had a crystal ball and could see into the future, we would not need to prepare ahead for end of life decisions. James was 62 years old when a stroke made it impossible for him to communicate with his family. Neither his wife nor children knew anything about his financial or medical information. James had always taken care of things himself and left no written directives in his behalf. Besides having to locate important documents, the family was left to make their own decisions about James long term care.

CORAL SPRINGS, Fla. – Quest Health Solutions' new Tokyo-based investor provides a “substantial boost,” allowing the diabetes provider to scale its business and expand its market reach – possibly even into Asia, says CEO Adam Nadler. The company announced last week that received an investment from Sumitomo Corp. through its U.S. subsidiary Sumitomo Corporation of Americas based in New York. “This is laying the better financial groundwork for us as far as our objectives and bringing the resources (to) scale our business even further,” Nadler said. “They have experience doing that and it’s great that we can kind of plug into their network and take advantage of that.” Sumitomo has been active in health care globally for years, but the investment in Quest represents its first in the U.S. health care market. Overall, the company operates in 66 countries and regions in sectors ranging from energy to mineral resources to urban development. Nadler says there may be opportunities to add new product categories, but right now, Quest is focused on being an expert in continuous glucose monitoring – from the devices to patient management. In addition to its CGM business, the company has two sister companies, Quest Health Remote Care and Quest Health RPM Services. “It’s not just about wearing the device, it’s about educating the patient and making those behavioral changes,” he said. “What’s going to set us apart is the way we keep patients out of the hospital and prevent readmissions.” Longer term, Nadler also wants to enhance the Quest brand and bring it to Japan and Malaysia, where Sumitomo operates several managed care corporations. “The health care market over there is slightly behind the U.S. health care market,” he said. “Sumitomo (sees) what we can bring over to Asia and over to their businesses there. There’s a lot of opportunity in the future.” Here in the U.S., Quest operates in 48 states. Nadler founded the company in 2017, after exploring different diabetes supplies, including shoes, before turning to CGMs. “I realized there was an opportunity for us to get in on the ground floor of CGMs – it was so early we didn’t even know what the HCPCS codes or reimbursement were,” he said. “It’s been an exciting space that’s (now) appealing to people from outside the industry, as well.”**MORE**

NEW YORK – Parachute Health’s decision to embed prior authorization workflows into its platform is an example of how payers are increasingly driving the transition to e-prescribe, says David Gelbard. The company announced in June that it added the functionality through a partnership with Optum, which is owned by UnitedHealth Group, and Walgreens/CareCentrix. “There’s a favoring by payers to do business in a digital way vs. paper fax,” said Gelbard, CEO and founder of Parachute Health. “What will be important for DME providers is their continued progression to be digitized and to move toward e-prescribe, because it will be the baseline of competition going forward. No one wants the paper process to continue – definitely not payers.” Parachute Health’s news followed an announcement by Optum that it had launched DME Navigator, an end-to-end solution for benefits management that includes an EHR-integrated ordering platform, through a collaboration with Walgreens/CareCentrix. Gelbard says Optum reached out to Parachute Health to see if the company was willing and able to automate the prior authorization process in its e-prescribing platform. “As they were evaluating the DME benefit, it became obvious the way forward to drive efficiency and transparency was to leverage e-prescribe and embed and automate the authorization process,” he said. “That was the catalyst.” In what he calls a “win-win,” Gelbard says this new functionality also increases transparency and efficiency for providers. “The current process for managing authorizations is too burdensome,” he said. “It takes up too much administrative time; it results in delays in care.” Additionally, the new functionality gets ahead of a CMS rule that requires impacted payers to implement an Application Programming Interface (API) that enables electronic prior authorization requests by 2027. “That will be the next big altitude in e-prescribing and prior authorization,” he said. **MORE**

YARMOUTH, Maine – Weather events like hurricanes and tornadoes are happening more frequently and are stressing cash-strapped HME providers and an already fragile delivery system, say the majority of respondents to a recent HME Newspoll. About 76% of respondents report being in an area affected by weather events and of those about 64% report these events are happening more frequently. The biggest impact on their operations: Increases in costs like labor and gas. “Patients have unrealistic expectations (related to) power outages,” wrote Erin Dolan of Med-Essentials in New Hartford, Conn. “(They expect) to rely on backup (oxygen) tanks for days and that we will deliver replacements at excessive frequency. We try to educate them that they need to have a backup plan (generator, alternate location), but with each storm, we expect an onslaught of tank orders. We also spend a lot of time making calls to home-based patients to reexplain battery backup in hospital beds – how long patients can remain on an air mattress, etc.” AAHomecare recently asked providers to share how they go above and beyond to ensure their customers continue to receive vital equipment and services during weather events. Increased awareness of the role providers play in making sure patients remain safe and healthy during and after weather events could help to address lack of reimbursement and other support. All respondents – 100% - report that Medicare and other insurers aren’t doing enough in that area. “It would be nice to have a procedure code for ‘emergency call due to weather-related event,’” wrote one respondent. “This was never part of the ‘normal cost of doing business’ and, thus, was never factored into reimbursement.” Added another respondent: “There’s no additional reimbursement when we are delivering tanks after hours to rural patients who have lost power due to storms. (It) would be nice if it was billable.” Other impacts on providers from weather events include delays in product and service delivery (about 8%) and a reduction in employee availability (about 17%). “When we are hit by a hurricane, we are unable to get staff here and sometimes are limited by Internet access due to Internet provider line damage,” wrote one respondent. “Our staff cannot make it into work, and we have to prioritize our deliveries by emergency only.” Share stories of how you go above and beyond during weather events by emailing Ashley Plauché, AAHomecare’s senior director of brand marketing, atashleyp@aahomecare.org. **MORE**

CARLSBAD, Calif. – Advanced Diabetes Supply recently expanded its Part B services to retail pharmacies to include management of diabetes supplies.  The move made sense for ADS, which has already been partnering with pharmacies to offer continuous glucose monitors, says CEO Bill Mixon. “CGM is central to what we do, but we provide other diabetes testing supplies that these patients might need,” he said. “We can fulfill those through the DME benefit, which is difficult for the pharmacy to handle well.” To make it all work, ADS connects with the pharmacy’s workflow systems and contacts patients within 24 hours to “take over” management of CGMs and other diabetes supplies. The company educates and trains, communicates about refills, obtains prescriptions and necessary documentation, and collects reimbursement. With about 80% of CGM medical records and prior authorizations at least one component shy of meeting requirements, ADS’s expertise in Part B billing is key to pharmacies, says Mixon. “Pharmacies tend to be oriented around high-volume prescriptions,” he said. “We, as a CGM DME provider, have a much more hands-on approach, where we work with the patient to make sure they are using the technology to drive better health outcomes and allow the pharmacy to focus on other business.” Since initially partnering with pharmacies to offer CGMs in 2020, ADS has contracted with Medicare and more than 500 private insurers, serving more than 60,000 patients on behalf of about 12,500 national and regional pharmacies. A patient re-order rate of 96% points to how well the program works for pharmacies and patients, say Mixon. “The pharmacy’s patients have a great patient experience, and it leads to ongoing retention for the pharmacy,” he said. “We’re very focused on education and being a resource for the patient.” Bill Mixon made the leap from wheelchairs to diabetes supplies in 2023. **MORE**

WASHINGTON – NCART has submitted a HCPCS coding application to formally appeal CMS’s decision to only increase the fee schedule for seat elevation systems by about $13 to $2,013.96. “While we appreciate CMS’s willingness to listen to our concerns and review the follow-up information we provided, they indicated it could not be considered, since it was not part of the public meeting process last year,” said Wayne Grau, executive director of NCART. “In addition, we will highlight the problems using Internet pricing, which does not reflect the additional significant costs to comply with Medicare requirements compared to that retail model.” Previously in March, CMS established a new code, E2298, for seat elevation systems and set reimbursement to about $2,000 effective April 1. On an interim basis prior to April 1, CMS was paying about $2,800, on average, for seat elevation systems. CMS adjusts requirements for replacements WASHINGTON – CMS will require prior authorization for all power mobility devices being replaced within the five–year useful lifetime effective June 2, NCART reports. Providers should submit prior authorizations as an expedited request and the agency will process them within two business days. For wheelchairs being replaced due to loss, theft or irreparable damage, the following should be included with the request: information and/or detailed reports that explain the reason leading to the need for replacement, such as policy report when the PMD is lost or stolen; and a physician’s written order prior to delivery (WOPD) for the new replacement items. If CMS affirmed the original prior authorization, the DME MACs will not review for medical necessity. Once the request is affirmed, providers should submit the claim with the RA modifier. For wheelchairs being replaced due to change in medical need or reasonable useful lifetime met, the following should be included with the request: a new face-to-face evaluation, WOPD and documentation from the medical record that supports the need for the item and documentation to support the change in condition, if applicable. REMSleep receives clearance, details marketing plan CLEARWATER, Fla. – REMSleep Holdings has been awarded 510(K) clearance from the U.S. Food and Drug Administration for its new Deltawave CPAP Pillows Interface mask.  With the clearance, the company has begun preparing the Deltawave for market by updating its website and ordering a large inventory. REMSleep has also announced a strategic marketing plan for Deltawave that includes identifying key distributors, providing comprehensive training to those distributors, expanding its reach, and launching marketing and awareness campaigns. "We are incredibly excited about the future of REMSleep  and the tremendous potential of Deltawave,” said CEO Tom Wood. “Our journey ahead is filled with immense opportunities, but we recognize that it will require both strength and patience to achieve our corporate goals. We are committed to identifying and collaborating with the best distributors to ensure that Deltawave reaches those who need it most. Our team is dedicated to advancing our technology, expanding our market presence, and ultimately improving the lives of countless individuals affected by sleep apnea.” Deltawave’s features include the ability to support normal breath rate and a reduction in the need (or no need) for humidification. AOPA announces award recipients ALEXANDRIA, Va. – The American Orthotic and Prosthetic Association (AOPA) has announced the recipients of the 2024 Howard R. Thranhardt Award are Andreas Kannenberg, MD (GER), PhD, Shane Wurdeman, PhD, CP, FAAOP (D), Tyler Klenow, MSPO, MBA, CPO, FAAOP, and Russell Lundstrom, MS. The award, established in 1996 through a gift from J.E. Hanger in memory of Howard R. Thranhardt, CP, has become one of the most distinguished honors in the orthotics and prosthetics profession, annually recognizing the strength in clinical research. “Their work will contribute to the profession’s clinical base, helping to improve and further the care provided to the individuals we are privileged to serve,” said Mitchell Dobson, CPO, FAAOP, president, AOPA.  “Their presentations are just two of the informative and exciting educational sessions you will experience at this year’s National Assembly. We look forward to congratulating and honoring them for these accomplishments.” The award and presentations will be given Sept. 14 in conjunction with the 2024 National Assembly in Charlotte, N.C. Kannenberg and Wurdeman will present “Assessing Outcomes with Microprocessor Knee Utilization in a K2 Population (ASCENT K2): Findings from a Clinical Trial of 107 Individuals with Above-knee Amputation.” Klenow and Lundstrom will present “Reduction in Falls and Fall-Risk with Increased Walking Speed Found Following 1 Year of C-Brace Use: Interim Results from the C-Brace Registry.”  AmeriCare Medical’s nurses recognized TROY, Mich. – AmeriCare Medical has received recognition from thestate of Michiganfor its exceptional work in home care. Leaders from thestate'sHouse of Representatives delivered a tribute that honored and commended AmeriCare Medical's team of registered nurses and their commitment to excellence in health care. "At AmeriCare Medical, our nurses are the heart and soul of our organization," saidGreg Jamian, president and CEO. "They embody the values of compassion, integrity and expertise, delivering personalized care that enhances the quality of life for our patients every day." For more than four decades, AmeriCare Medical has provided the gold standard in home care, employing a team of more than 250 health care professionals who serve across hospitals, government facilities and private residences statewide.  Soleo Health tapped to distribute IG drug FRISCO, Texas – Soleo Health has been named a limited distribution specialty pharmacy partner for GC Biopharma USA, Inc. to dispense ALYGLO (Immune Globulin Intravenous, Human-stwk) 10% Liquid for adults with primary humoral immunodeficiency (PI). "Our partnership with GC Biopharma underscores our shared commitment to enhancing patient care and showcases Soleo Health's unparalleled expertise in managing patients with complex conditions,” said Drew Walk, CEO. “We are honored to be chosen as a partner for ALYGLO, highlighting our ability to provide individualized patient services across various care settings.” Soleo Health has deep clinical knowledge and experience in the provision of immunoglobulin (IG) services and its ability to collect real-world evidence clinical outcomes through SoleMetrics, its proprietary clinical outcomes program.  HME News recently interviewed Walk and Craig Vollmer about Soleo Health’s map for the future. HME Home Health receives recognition for Dove Mattress RICHMOND, B.C. – HME Home Health has received the CAOT Seal of Recognition for its award-winning HME Signature Series Dove Mattress. “Since the 2023 launch, the HME Signature Series Dove Mattress has won multiple awards, including the BC Care Providers Safety Product Innovation Award, and now we are thrilled to have received the CAOT Seal of Recognition,” said Robert Boscacci, co-founder and CEO. “The HME Dove is now the leading low air-loss mattress in B.C. and is leading the market in safety and innovation.” HME Home Health offers a wide range of mobility and accessibility devices and medical equipment, including wheelchairs, walkers, hospital beds, lifts, ramps and other installed products. Read about why HME Home Health began making products in response to supply chain disruptions.