Florida Durable Medical Equipment and Home Medical Equipment

Florida Durable Medical Equipment and Home Medical Equipment As a personal injury firm who provides services to many chiropractors, medical doctors, and physical therapists one of the most frequently misunderstood  parts of medical billing is reimbursement and billing for Durable Medical Equipment (“DME”) and Home Medical Equipment (“HME”).

What is Durable Medical Equipment?

According to Medicare.gov DME meets these criteria:

• Durable (can withstand repeated use)
• Used for a medical reason
• Not usually useful to someone who isn't sick or injured
• Used in your home
• Has an expected lifetime of at least 3 years

DME that Medicare covers includes, but isn't limited to:

• Air-fluidized beds and other support surfaces (these supplies are only rented)
• Blood sugar monitors
• Blood sugar (glucose) test strips
• Canes (however, white canes for the blind aren't covered)
• Commode chairs
• Continuous passive motion (CPM) machine
• Crutches
• Hospital beds
• Infusion pumps and supplies (when necessary to administer certain drugs)
• Manual wheelchairs and power mobility devices
• Nebulizers and nebulizer medications
• Oxygen equipment and accessories
• Patient lifts
• Sleep apnea and Continuous Positive Airway Pressure (CPAP) devices and accessories
• Suction pumps
• Traction equipment
• Walkers

As listed by Medicare the definition covers a broad amount of items. Therefore when asking the question is “this” item a DME. If it can be used repeatedly over time, is used for a medical reason, and in someone's home, then the answer is probably yes.

What is Home Medical Equipment?

Florida Statute 400.925(6) defines Home Medical Equipment as: “[A]ny product as defined by the Federal Drug Administration's Drugs, Devices and Cosmetics Act, any products reimbursed under the Medicare Part B Durable Medical Equipment benefits, or any products reimbursed under the Florida Medicaid durable medical equipment program. Home medical equipment includes oxygen and related respiratory equipment; manual, motorized, or customized wheelchairs and related seating and positioning, but does not include prosthetics or orthotics or any splints, braces, or aids custom fabricated by a licensed health care practitioner; motorized scooters; personal transfer systems; and specialty beds, for use by a person with a medical need.”

Who is a provider of “Home Medical Equipment and Services”?

Florida Statute 400.925(7) defines home medical equipment provider as: “ [A]ny person or entity that sells or rents or offers to sell or rent to or for a consumer:(a) Any home medical equipment and services; or (b) Home medical equipment that requires any home medical equipment services.” As the definition under what a DME, HME and HME provider as very broad it is safe to assume that if you are prescribing and selling medical equipment in Florida that you would be falling under the guidelines of this statute.

Who needs a license?

This portion is controlled under Chapter 59A-25.002(1), Florida Administrative Code (FAC):

1. Any person or entity that holds itself out to the public as providing home medical equipment and services or accepts physician orders for home medical equipment and services is subject to licensure under this part.
2. Any person or entity that holds itself out to the public as providing home medical equipment that typically requires home medical services is subject to licensure under this part.
3. The requirements of part II of chapter 408 apply to the provision of services that require licensure pursuant to this part and part II of chapter 408 and to entities licensed by or applying for such licensure from the agency pursuant to this part. A license issued by the agency is required in order to provide home medical equipment and services in this state.
4. A separate license is required of all home medical equipment providers operating on separate premises, even if the providers are operated under the same management 59A-25.002(1), Florida Administrative Code (F.A.C.) Home medical equipment locations requiring a license are any locations that sell, rent, or distribute, or offer to sell or rent to or for a consumer any home medical equipment that requires services.

These locations can be identified as follows:

a. Any location providing or distributing home medical  equipment requiring services to consumers in Florida;

b. Any location where an intake person takes calls from consumers in Florida and offers to sell or rent home medical equipment requiring services;

c. Any location there a consumer in Florida may call in response to a provider advertising to sell or rent home medical equipment requiring services,; e.g., television advertisements, toll-free telephone numbers, phone books, newspapers, flyers or any other forms of public advertisement;.

d. Any location out of state that offers to sell or rent home medical equipment requiring services to consumers in Florida;

e. Any location in state or out of state, with sales representatives working in Florida, that offers to sell or rent home medical equipment requiring services to consumers in Florida, i.e., the sales representatives themselves do not need to be licensed; and

f. Any buildings, that are not located at the licensed central service center address, called shops, warehouses, distribution centers, or called by any other name, are required to have a license if that site location provides selection (via telephone, showroom or sales representative), delivery, set up, consumer instruction or maintenance of equipment to consumers in Florida. 1. A central service centers must provide the names and locations of all of its designated distribution centers on the licensure application. 2. A distribution centers must submit a separate licensure application and must specify the name of its central service center on the application. 3. Each licensed distribution center is required to meet all standards for licensure but may be determined to meet the standards through the activities of its designated central service center as referenced in paragraph 59A-25.005(1)(b), F.A.C.

Who is exempt from having a HME License?

I hear a lot from doctors that they believe they are exempt from having the license under the Centers for Medicare and Medicaid Services (CMS) standards exempting physicians. The definition of physicians covers chiropractors in the State of Florida, so I get a lot that they are exempt. However, this belief is misguided when it comes to Florida Law. While it may be exempt under CMS standards all physicians must also comply with the state law. Florida Statute 400.93(5) serves the only list of exempt professionals or organizations from the HME license requirement. It states: “The following are exempt from home medical equipment provider licensure, unless they have a separate company, corporation, or division that is in the business of providing home medical equipment and services for sale or rent to consumers at their regular or temporary place of residence pursuant to the provisions of this part:

1. Providers operated by the Department of Health or Federal Government.
2. Nursing homes licensed under part II.
3. Assisted living facilities licensed under chapter 429, when serving their residents.
4. Home health agencies licensed under part III.
5. Hospices licensed under part IV.
6. Intermediate care facilities, homes for special services, and transitional living facilities licensed under part V
7. Hospitals and ambulatory surgical centers licensed under chapter 395.
8. Manufacturers and wholesale distributors when not selling directly to consumers.
9. Licensed health care practitioners who utilize home medical equipment in the course of their practice, but do not sell or rent home medical equipment to their patients.
10. Pharmacies licensed under chapter 465.”

As you can see, there is no exemptions to the law for being a physician. Therefore, I highly recommend not chancing the judge's determination of an HME in your case.

Is there a penalty for selling or renting HME's without a license?

Yes, there is a scary one. Florida Statute 400.93(6)(a) states: "A violation of s. 408.812 is a deceptive and unfair trade practice and constitutes a violation of the Florida Deceptive and Unfair Trade Practices Act. (b) A person who violates s. 408.812 commits a misdemeanor of the second degree, punishable as provided in s. 775.082 or s. 775.083. A person who commits a second or subsequent violation commits a misdemeanor of the first degree, punishable as provided in s. 775.082 or s. 775.083. Each day of continuing violation constitutes a separate offense. The maximum fine for a misdemeanor of the first degree is $1000. For a misdemeanor of the second degree it is $500. Therefore, if you have been prescribing HME's for years and assuming you have 500 total prescription that fine could be multiplied by $500, or $500k. So is the requirement hassle not worth the squeeze anymore? I think not.

How do I get my Home Medical Equipment License?

To apply for a HME license through the State of Florida, go to: https://ahca.myflorida.com/mchq/HQALicensureForms/index.shtml#hme, For frequently asked questions on licensing, go to: https://ahca.myflorida.com/MCHQ/Health_Facility_Regulation/Home_Care/Home_Medical_Equipment.shtml or https://ahca.myflorida.com/MCHQ/Health_Facility_Regulation/Home_Care/HME_FAQs.shtml At Dolman Law Group Accident Injury Lawyers, PA we are a full service personal injury law firm servicing all of Tampa Bay including but not limited to Sarasota, Bradenton, St. Petersburg,  Clearwater, Dunedin, Palm Harbor, Safety Harbor, Trinity, Tarpon Springs, New Port Richey and many more. If you need more guidance regarding if your office is billing properly please reach out to us at 727-222-6922 or [email protected]