Comments on a Proposed LMRP:
Pennsylvania (2nd Comment)

This letter can serve as a model on commenting on a local medical review policy (LMRP). Because all proposed LMRPs will vary to some extent, you will need to adopt this model to your specific situation.

See the response to this comment.

October 17, 2000

Dr. Andrew Bloschichak
Medical Director
HGSAdministrators
P.O. Box 890413
XACT Medicare Services
1800 Center Street, 1A-L4
Camp Hill, PA 17089

Re: Supervision Requirements for an Independent Diagnostic Testing Facility Draft Local Medical Review Policy

Dear Dr. Bloschichak:

Enclosed please find a copy of our letter to you dated September 19, 2000, regarding the direct supervision rule proposed for IDTF-based services. We know that you have received a number of comments on the proposed supervision standard. We appreciate how difficult it must be for you to respond to each of these commentators. However, we are hoping that you might be able to communicate with us, as many of our members have expressed concern over the proposal and we are attempting to determine if the matter can be resolved prior to the time that the proposed rule would go into effect on October 23, 2000. If it does not appear that a resolution can be worked out prior to the implementation date, we would like to propose a conference call with you and Terrence Kay of the Health Care Financing Administration ("HCFA") at the end of this week or the beginning of next week.

Mr. Kay recently spoke to the Society of Vascular Technology and the Society of Diagnostic Medical Sonography regarding HCFA's planned implementation of a general supervision rule for basic ultrasound services as part of its national payment policy initiatives. Since we believe that this standard would supersede the proposal that you are considering, we think that a conference call with Mr. Kay might be helpful. We propose to call you later this week to determine the status of your deliberations and, depending upon your sense of the current status of the policy, we can try to make arrangements for the conference call.

We have heard differing assessments of what the current status of the proposal is. Some of our members have reported that the Pennsylvania carrier will be retracting the proposal. Others have stated that the proposal will be going forward as proposed. Still others have indicated that the proposal will be altered by some subsequent Medicare Bulletin notice. Some of these individuals have suggested that the Pennsylvania carrier will be permitting the availability of telephone contact only as a substitute for direct supervision. Others have said that, although some adjustment will be made to the direct supervision standard, the adjustments will be retroactive from the date of the Medicare Bulletin notice to the original implementation date for the original proposal, that is, October 23. Given the various understandings of what the current status of the proposal is and the concern about the potential for a retroactive application of some as yet unstated modification to the proposal, we are anxious to learn more about the Pennsylvania carrier's intentions and the standards to which our members will be held. The current, rather confusing state of affairs is making it difficult to advise our members. Since we know that you obviously are interested in providing clear standards, we look forward to working with you to address the current situation.

Thank you for your kind attention to this matter. We look forward to speaking with you soon.

Sincerely,

Patricia Marques, RN, RVT, FSVU
President
Society of Vascular Technology

Anne Jones, BSN, RN, RVT, RDMS, FSVU
Legislative Chair
Society of Vascular Technology

Frank West, BSN, RN, RVT, CVN
Society of Vascular Technology

Stephen McLaughlin, BS, RT, RDMS
President
Society of Diagnostic Medical Sonography

Laurinda Andrist, BS, RDMS, RDCS
Legislative Chair
Society of Diagnostic Medical Sonography