From the Competitive Bidding Implementation Contractor (CBIC)

Educational Information

Round 2 Zip Codes for New Jersey

Eli Lehrer, The Weekly Standard, August 15 - August 22, 2011, Vol. 16, No. 45

Sometime late this summer—the Friday before Labor Day if historical patterns hold—the Centers for Medicare and Medicaid Services (CMS) will announce the beginning of something called Medicare Round Two of “the Competitive Bidding Program for certain Durable Medical Equipment, Prosthetics, Orthotics, and Supplies.” Although it sounds obscure, this bidding process’s manifest flaws could have serious consequences for just about every American who needs medical care. Shortages of vital devices could develop, medical supply companies could go out of business, medical innovation could slow, and, if things go as badly as some economists think they will, health care costs could skyrocket as the direct result of a program intended to control them. 

The story of the bidding process for what insiders call DMEPOS provides a fascinating case history of how broadly supported “good government” schemes can have serious negative consequences in the hands of ambitious bureaucrats. Let’s begin with some background. Durable medical equipment, prosthetics, orthotics, and supplies, i.e., DMEPOS, are goods used primarily outside of hospitals. The category includes everything from crutches to pacemakers. DMEPOS are mainly distributed through small “home care/durable medical equipment” businesses that earn most of their revenue through “market rate” reimbursements under the Medicare program. The current purchasing process has problems: Among other things, prices for the same equipment differ quite a bit between regions, invoices rarely track manufacturing costs, and quality problems crop up more frequently than they should. 

In an effort to save money for Medicare while boosting quality, Medicare began full-scale competitive bidding for some products under the 2003 law adding prescription drug coverage to Medicare. Under that law and an additional package of Medicare tweaks passed in 2008, the bidding process would begin in a few areas and, if successful, expand. (The 2010 health care law accelerates this expansion.) At the time, it seemed like common sense, good-government thinking. Supporters of bidding processes included the George W. Bush administration, then Senate majority leader Bill Frist, and Frist’s late Democratic colleague Ted Kennedy. CMS claims it will obtain average savings of nearly 20 percent, or about $1.5 billion out of the more than $8 billion Medicare spent on DMEPOS in 2009.

Despite a long buildup period, however, nobody paid much attention to the process until CMS announced a plan for a bidding system that raised questions for just about every expert that has looked at it. 

“Neither I nor anyone else have ever seen any bidding process anywhere that works this way,” says University of Maryland professor Peter Cramton, an economist who has closely followed the Medicare bidding process. And nearly 250 university and industry economists who study market-design economics have signed Cramton-drafted letters to the president and CMS expressing grave concerns about the process and suggesting that it be halted until its flaws can be worked out. (There’s no groundswell of academic support on the other side.) 

The fundamental problem lies in the way that CMS’s market design crashes the established procedures for government contract bidding. In a conventional bidding process for a government contract, qualified providers submit bids offering specific quantities of a product at a particular price. The bidding process ends when the total that the providers offer equals expected demand. This is called the “market clearing price.” If, for example, CMS decides there’s a need for 100 walkers and gets bids of 25 walkers for $90 each, 25 walkers for $110 each, 50 walkers for $140 each, and 100 walkers for $150 each, it would establish a “clearing price” of $140, hold all bidders to their bids, and decline to do business with the company that wanted $150. This process becomes considerably more complex in real-world settings, but its fundamental efficiency in meeting demand at the lowest cost ranks among the best-established conclusions in the field. 

While it takes bids in a normal fashion, however, the CMS process insists that Medicare will pay everyone the median of the “winning” prices. ($110 rather than $140 in the above example.) As a result, some bidders will be paid less than they bid while others will be paid more. Unlike in a conventional government bidding process, CMS neither requires bidders to prove they can deliver a product before bidding nor to actually deliver it afterwards. And unlike all other government auctions outside of the national security realm, CMS reveals little besides winners’ names to the public.

All these features could cause major problems. Since bidders don’t have to honor their bids or prove they can meet them in the first place, they have enormous incentives to bid less than their actual costs, because doing so gives them a zero-risk option to sell to CMS at a price that may be higher than the bid anyway. Since CMS pays less than the likely-to-be-low “clearing price,” however, the system essentially guarantees that some will have to sell at a loss or drop out and thereby threaten their own survival. Finally, since nearly everything is kept secret, CMS’s own officials are free to manipulate contracts however they want. The result is a disaster waiting to happen for the market as a whole. 

In the trial areas, problems have already emerged. Diabetics have run into difficulty getting supplies that work with their testing meters and CMS has had to rejigger delivery quantities for almost every major item it has put out for bids. While these short-term fixes have prevented calamity, the fragile, nearly arbitrary process that now exists could show real strains as soon as the “round two” process expands current practices to a total of 91 metropolitan areas that collectively contain almost the entire population.

In fact, just about every independent study of the process makes decidedly dour predictions. One report from the Pacific Research Institute finds that CMS’s methods could reduce investment in medical device markets by as much as $3.1 billion over a 10-year period (essentially stopping the development of new high-tech devices) and cost $50 billion in terms of reduced life expectancy. Another report from the American Consumer Institute finds that the process’s consequences for one category of equipment—vacuum pumps that help heal serious wounds—would increase medical costs by $6.8 billion if it slows the technology’s rollout. “The CMS bidding process is so flawed that it will fail to find sustainable market prices for medical equipment,” says Steve Pociask, ACI’s chief economist and the study’s author. But CMS has given every indication it plans to push forward with the process unchanged.

And that’s where the bureaucratic interests come in. Since the process puts low prices above all other considerations, it will almost certainly produce savings of more than the 20 percent that experiments have shown, and its designers will look very smart. With only a few areas and a few classes of products in play, however, firms may have been willing to take losses up until now just to stay in the running. The people running the program at CMS probably hope they will emerge looking like geniuses who saved taxpayers billions, while the home care industry will get the blame as quality falls, shortages develop, deliveries become irregular, innovation ceases, and more people end up in hospitals. 

Cramton adds an important note. “It’s rare to see something like this happening in the absence of an organized interest group on the other side,” he told me. “Usually somebody benefits from the flaws in a process. Here, no special interest group benefits.” Unless, of course, one believes the CMS’s own leadership ought to be counted as another special interest group with an agenda all its own.

Eli Lehrer is vice president of the Heartland Institute.

Keeping Members Informed

          PRESS RELEASE

Contacts: 

Wendy Russalesi, JAMES, 732-503-5665, wrussalesi@jamesofnj.org

Peter Lillo, Insight Consulting Services, 609-396-9000, petelillo@yahoo.com

Kevin DeSimone, Insight Consulting Services, 609-396-9000, kdesimoneics@gmail.com

JAMES Testifies at NJ Senate Health, Human Services and Senior Citizens Committee Roundtable

Testimony focused on the challenges of Medicaid managed care for a high-needs population

JACKSON, NJ, June 6, 2011 - Dr. Kevin Saluck, JAMES President and Vice President of Clinical Operations and Business Development for Central Medical Supply Group testified today at the New Jersey Senate Health, Human Services and Senior Citizens Committee roundtable about the concerns the association has with the Comprehensive Medicaid Waiver.

“Home medical equipment companies provide a valuable service to thousands of patients who are in need of medically necessary supplies and equipment that include recurring, monthly orders for medical supplies, complex rehab mobility equipment and clinical respiratory services, such as life sustaining patient ventilation,” stated Dr. Saluck.

The state proposes moving 121,000 aged, blind and disabled (ABD) Medicaid recipients into mandatory managed care programs from the current Medicaid fee-for-service program, beginning on July 1, 2011. 

Not only does the proposal itself present a myriad of challenges, but the extremely short time frame in which this transition will occur is alarming.  “Clinical respiratory patients who often take from several weeks to a couple of months to safely transition to another provider will be subject to this process almost overnight,” Dr. Saluck told the Committee. 

Family members of Medicaid recipients testified before the Committee today about the lack of clear information that has so far been provided to them regarding the transition.  Family members and durable medical equipment companies impacted by this proposal can communicate electronically with their legislators at www.jamesofnj.org.

The Jersey Association of Medical Equipment Services (JAMES), established in 1978, disseminates information related to the delivery of Home Medical Equipment to providers of these services. It is the goal of the organization to keep its members informed of industry changes and related information necessary to maintain quality of care in providing home medical equipment, supplies and services to the patients who rely on us.  Our membership is comprised of more than 70 members and manufacturers doing business in the state of New Jersey.  For more information, please visit www.jamesofnj.org or contact us by phone at 732-503-5665.

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JAMES Senate Health Committee Testimony June 2011

Prepared by the American Association for Homecare:

Auction Expert Tells Hill Staff CMS Is Doing an Atrocious Job with Bidding Program

Congressional staff heard from critics of the Medicare bidding program for home medical equipment in House and Senate briefings held on May 24.  University of Maryland auction expert Peter Cramton presented a PowerPoint, with the lead slide titled: “Bad news: CMS is doing an atrocious job with the DME auction program.”  Cramton said that because of the lack of transparency under its system, CMS can manipulate prices to get to allowable reimbursement rates that it thinks are “reasonable” and bidders can manipulate quantities to manipulate price. Cramton said, "the program is fatally flawed and it is going to fail.

To learn more about the bidding system, visit www.aahomecare.org/competitivebidding.

The Jersey Association of Medical Equipment Services (JAMES) has retained the Government and Public Affairs firm, Insight Consulting Services.  They are located in Trenton, NJ, and also have a separate government relations firm in Washington, DC - Patriotic Consulting Services.

The principal of the firm, Pete Lillo, has over 30 years of state and federal government experience, working in and with many elected officials, on all levels of government.  The firm is one of the leading healthcare advocates, and represents a myriad of provider groups, as well as those who do business with healthcare organizations, both on a state and national level. Pete and his team have worked many years with healthcare officials, developing strong relationships with Governor's staff, Commissioner's of key departments and staff, as well as leading legislators in both the Assembly and the Senate. They are a true bipartisan firm, and have worked well in budgetary issues facing their current clientele. 

They handle legislative initiatives, from drafting of bills, to writing testimony, putting together industry white-papers, arranging meetings, and being very aggressive in their outreach. 

Kevin DeSimone, along with Mr. Lillo, will collaborate to effectively address the political needs of our association.  Kevin has many years working with former legislators, including the current Assembly Health Chairman, the current Assembly Budget Chairman, and working with former Health Commissioner Heather Howard.  The rest of the Insight team will also be active in assisting in the formulation of policy, ongoing dialogue with key individuals, and pushing the agenda we have set forward.  Other staff members include a staff attorney, and a public relations specialist.

We look forward to working with them and having our issues met with many stakeholders.

www.insightconsultingservices.net

CONTACTS: Wendy Russalesi, 732-503-5665, info@jamesofnj.org
                 Michael Reinemer, 703-535-1881, michaelr@aahomecare.org

JACKSON, NJ, March 29, 2011 ---- The Jersey Association of Medical Equipment Services strongly endorses bipartisan legislation to repeal the misguided and deeply flawed Medicare “competitive” bidding program for home medical equipment and services (durable medical equipment). The bill, H.R. 1041, was introduced by Congressmen Glenn Thompson (R-Pa.) and Jason Altmire (D-Pa.) on March 11, 2011 and is titled the “Fairness in Medicare Bidding Act.”

Wendy Russalesi, executive director of the Jersey Association of Medical Equipment Services, commented, “The Medicare bidding program for home medical equipment will affect many of the 1.3 million Medicare beneficiaries in New Jersey. This program will delay access to necessary medical equipment, reduce the quality of the medical equipment provided, and place additional economic strain on the small business community of New Jersey.”
The bidding program was implemented on January 1, 2011 in nine metropolitan areas (MSAs) across the U.S. and will expand to an additional 91 areas later this year including three MSAs in New Jersey beginning this year. Those three areas cover 80 percent of the state.

The bidding applies to medically required oxygen therapy, enteral nutrients (tube feeding), continuous positive air pressure (CPAP) and respiratory assistive devices, power wheelchairs, walkers, hospital beds and support surfaces, and mail-order diabetic supplies.

The American Association for Homecare has received hundreds of complaints about the bidding program from beneficiaries, physicians, case managers, and homecare providers. These complaints will increase exponentially as the program progresses because the payment rates established under this system are unsustainable over the long term. These payment rates are leading to the provision of lower-quality medical equipment and reduced services associated with home medical equipment.

"Of all the items that impact healthcare at home, Medicare had chosen the most service-intensive therapies for bidding including home oxygen, sleep apnea devices and enteral feeding,” said Bob Miller of Bach's Home Health Care, located in Hackettstown, NJ. “You cannot bid out 24-hour emergency service, constant re-education to patients to avoid additional hospitalizations or skilled nursing facilities, and the dialogue and interaction between physicians and the healthcare professionals we employ. Once these items are bid upon, all the services provided today at NO cost to Medicare patients suffer. Home care solves problems, it does not create them. Compare a month’s worth of home oxygen, which includes 24-hour service, at around $175 per month to your monthly cable TV bill of over $200 and you determine where the real value is in homecare!"

A number of patient advocacy and consumer groups also support H.R. 1041 – the ALS Association, the Brain Injury Association of America, the Christopher and Dana Reeve Foundation, the International Ventilator Users Network, the Muscular Dystrophy Association, National Emphysema and COPD Association, the National Council on Independent Living, the National Spinal Cord Injury Association, and United Spinal Association, among others.

The Jersey Association of Medical Equipment Services opposes the program for three key reasons:

It Sacrifices Care for Seniors and People with Disabilities
The program restricts access to and choice of home medical equipment and services. It triggers a race to the bottom in terms of quality. Less expensive items will be provided to patients. With fewer providers, expedient delivery of items and services will be eliminated and Medicare costs will increase.

The Program Is Anti-Competitive and Kills Jobs
The bid program is anti-competitive. By design, the program severely and artificially restricts the number of companies that are allowed to provide the equipment and services that are subject to bidding. The Association estimates that this program will result in approximately 100,000 job losses nationwide.

Not Cost-Effective, Not a Solution for Health Care
The bidding program will increase Medicare costs. It disrupts the continuum and coordination of care between doctors, discharge planners, patients, and homecare providers. It will lead to longer, more expensive hospital stays and more physician office visits, nursing home admissions, and emergency room visits.

Since the January 1 implementation of the bidding program in nine areas in the U.S., the following types of problems and complaints have been reported:

•  Difficulty finding a local equipment or service provider;

•  Delays in obtaining medically required equipment and services;

•  Longer than necessary hospital stays due to trouble discharging patients to home-based care;

•  Far fewer choices for patients when selecting equipment or providers;

•  Reduced quality; and

•  Confusing or incorrect information provided by Medicare.

In November, 2010, 167 leading economists, including two Nobel laureates and auction experts who have experience in the design and application of auctions around the world, warned Congress that Medicare’s bidding design for home medical equipment will fail. Those experts, who design market-based auction systems, found that this particular bidding program designed by Medicare has irreparable flaws that will prevent it from achieving its objectives of establishing accurate reimbursement rates while maintaining high quality equipment and related services. Under this system, the bidding companies are not bound by their bids, which undermines the credibility of the process and encourages “low-ball” bids that create an unsustainable process and threaten the long-term viability of the program.

Last year, a bipartisan group of 260 members of the U.S. House of Representatives supported legislation, H.R. 3790, to repeal the bidding program.

The Jersey Association of Medical Equipment Services (JAMES), established in 1978, disseminates information related to the delivery of Home Medical Equipment to providers of these services. It is the goal of the organization to keep its members informed of industry changes and related information necessary to maintain quality of care in providing home medical equipment, supplies and services to the patients who rely on us. Our membership is comprised of more than 70 members and manufacturers doing business in the state of New Jersey. For more information, please visit www.jamesofnj.org or contact us by phone at 732-503-5665.

The following is from HomeCare Monday:

The new bill to repeal DMEPOS competitive bidding, called the Fairness in Medicare Bidding Act, was introduced Friday by Reps. Jason Altmire, D-Pa., and Glenn Thompson, R-Pa.

“It would be a full repeal and be budget-neutral,” said Altmire press aide Tess Mullen.

The two congressmen, long champions of home care, will discuss the bill at a Capitol Hill press conference tomorrow morning. Altmire will further detail the bill in his scheduled speech at the AAHomecare conference on Wednesday, Mullen said.

The news comes just as providers are headed to the Hill on Thursday to talk to their legislators about competitive bidding.

“When [conference attendees] meet with representatives, they can direct them toward the bill we have introduced and highlight why it is really important to support the legislation into law,” Mullen said.

“I think it is important to Congressman Altmire that the people attending the legislative conference are articulate about how this program is affecting them and the patients on the ground,” she noted. “It does impact patients who rely on this equipment to live independently every day.”

Friday’s announcement got a jubilant reception from AAHomecare officials, whose goal was to get a repeal bill introduced in time for the association’s annual lobbying event.

“The American Association for Homecare and the Pennsylvania Association of Medical Suppliers, as well as a number of providers and manufacturers in Pennsylvania, have been working with the two congressmen over the past several months in sharing our concerns about competitive bidding and the harmful consequences the program poses to providers and beneficiaries of home care,” President Tyler Wilson said in a statement late Friday. “We’re pleased to see the congressmen taking action and we look forward to their press conference on Tuesday.”

Stakeholders said they are hoping for even greater support than that generated for a repeal bill last year. H.R. 3790 garnered 259 co-sponsors but never made it out of committee or picked up a Senate companion. Two weeks ago, however, Altmire and Thompson hosted a standing-room-only briefing for new legislative aides to bring them up to speed on competitive bidding. Some 25 staffers were turned away for lack of room.

Wilson said the 250 or so conference attendees can build on that foundation by relating their own experiences.

“They [will be] here to tell a story about their business, the people they employ, the beneficiaries they affect,” Wilson said.

Georgie Blackburn, vice president of government relations for Tarentum, Pa.-based Blackburn’s Pharmacy, plans to do just that. With the implementation of Round 1 competitive bidding, she said, “Now we can talk specifics: This is what is happening to our business and this is what is happening to our patients,” she said. “I can’t imagine anyone in Congress not wanting to hear that story.”

Even though Congress is grappling with problems on numerous fronts, this is a good time for the industry to press its case for a repeal of the bid program, Blackburn said. “I think the timing is excellent because we are in the first quarter of competitive bidding, and we’ve got real-life instances with our patients [to share],” she said. “We have data to underscore the need for the bill.”

“People get it,” added AAHomecare Vice President Mike Reinemer. “We just need to push it harder. Now that Round 1 has been implemented, there are some very real problems with access, confusion, more costly health care because of the inability to get into a home setting quicker. In that regard it is a very opportune time.”

Wilson said there is always a list of topics for industry advocates to discuss with legislators—this year’s includes audits, declining oxygen reimbursement and a separate benefit for complex rehab—but “there is no greater challenge to the industry than competitive bidding.”

Blackburn, whose company was awarded two Round 1 contracts, one in enteral nutrition and one in standard power chairs, said competitive bidding “affects your business the way you thought it would, but it also affects your business in many ways you didn’t expect.”

Because Blackburn‘s did not get a whole spectrum of contracts, she said, long-time referral sources have turned to those companies that did. “I’ve talked to many providers and this is happening cross the CBAs,” she said. “I think if we go en masse [and tell that story], that makes a statement.”

It could also make a difference.

“If we can sell everyone in Congress that [a repeal] is the right thing to do and then look at discretionary spending that would offset the bill—and not necessarily from the HME sector, which has been whittled down to nothing—I believe it can happen,” Blackburn said.

Those who can’t make it to the Legislative Conference can still push for H.R. 1041 through a virtual fly-in sponsored by the National Association of Independent Medical Equipment Suppliers. For information, click on “Virtual Fly-in” at www.dmehelp.org.

H.R. 1041 Dear Colleague Letter

H.R. 1041 Legislation

On February 22, Governor Christie revealed his proposed FY 2012 budget.  

Governor Christie is proposing mandatory managed care enrollment for 121,000 Aged, Blind and Disabled (ABD) recipients.  Of the 121,000 recipients 94,000 are Medicare / Medicaid dual eligibles.

We are asking all JAMES member companies, and non-member companies, who provide DME services within New Jersey to take a few mintues and complete our short survey by clicking the link below.

Our Medicaid committee is working to assess the impact of this budget proposal.

JAMES New Jersey Medicaid Survey

Prepared by the American Association for Homecare:

American Association for Homecare, Washington Report:

President’s 2012 Budget Proposes More Deep Cuts for HME

Several threats to home medical equipment reimbursement appear in the President’s 2012 budget, which was released this morning. The 2012 federal fiscal year begins in October of 2011.

On January 16, 2010, then-Acting New Jersey Governor Sweeney signed into law a requirement that managed care plans pay out-of-network suppliers directly for healthcare services rendered to a patient if the patient has assigned his or her health insurance benefits to the out-of-network supplier.  This new law, the "Assignment Law", will take effect on January 16, 2011.

JAMES Members:  Refer to Electronic Alert Vol. 3, No. 58 for an extensive article from David Barmak as to how this law will benefit you!

Jersey Association of Medical Equipment Services Elects New Board Members

JACKSON, NJ, October 7, 2010 – The Jersey Association of Medical Equipment Services (JAMES) elected new members to its Board of Directors at their annual conference, “Barriers to Boomers– How to Overcome and Prosper”.

Kathy Sircovitch of At Home Medical, and Jeffrey Reses of Lincoln Medical have been elected to serve terms on the Board of Directors that will expire in 2013.  They will serve alongside Bob Miller of Bach’s Home Health Care, Ron Manno of Core Care Technologies, Josh Parnes of Ocean Home Health and Seth Auerbach of Komfort & Kare. 

Currently serving terms on the Executive Board of Directors are Dr. Kevin Saluck, President, of Allcare Medical, Raymond Arthurs, Vice President, of First Care Medical Supplies, Tina Padden, Secretary, of Community Surgical Supply and Ben Hertz, Treasurer, of Elmora Healthcare.

An Associate Board Member position is currently held by Gary Brown, of Invacare. 

The Jersey Association of Medical Equipment Services (JAMES), established in 1978, disseminates information related to the delivery of Home Medical Equipment to providers of these services. It is the goal of the organization to keep its members informed of industry changes and related information necessary to maintain quality of care in providing home medical equipment, supplies and services to the patients who rely on us.  Our membership is comprised of more than 70 members and manufacturers doing business in the state of New Jersey.  For more information, please visit www.jamesofnj.org or contact us by phone at 732-503-5665.

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Visit focused on the value of services provided by HME companies

JACKSON, NJ, September 23, 2010 -  Carolyn Fefferman, Senior Advisor for Senator Robert Menendez’s Newark, NJ office visited a home medical equipment (HME) company at the request of the Jersey Association of Medical Equipment Services (JAMES).  JAMES is working with members of the New Jersey congressional delegation to educate them on the integral part HME companies play in the continuum of healthcare.   This visit was hosted by JAMES general member, Allcare Medical, at their corporate headquarters located in Sayreville, New Jersey.  Allcare Medical is a full service HME provider, with a scope of service that includes respiratory equipment and supplies, power mobility and custom rehab products, and orthotics and prosthetics. 

Ms. Fefferman received an extensive tour of Allcare Medical that included a visit to their corporate offices and distribution warehouse.  During this time, Ms. Fefferman met with staff at various levels within the operations of Allcare Medical, each one taking the time to detail their role within the organization and answer Ms. Fefferman’s questions.  Ms. Fefferman was able to understand the flow of operations and experience the efforts that are required to service an HME patient from the initial receipt of an order, all the way through to any follow-up maintenance and services that the patient may require.  Allcare Medical detailed the measures that are taken by the organization to ensure they are meeting compliance with the CMS Quality Standards, the DMEPOS Supplier Standards and the standards of their accrediting body, as well as all state and federal guidelines that are applicable to their operations.  Most importantly, they were able to help Ms. Fefferman to understand all of the services that are not separately reimbursable, but are a necessity for the delivery of a durable product by a company who is a Medicare provider. “After viewing the oxygen transfilling area and discussing the different back-up tank options, as well as options for portable oxygen, Ms. Fefferman learned that comparing internet pricing to current Medicare pricing is not an accurate comparison.  There is a vast difference between the services received when comparing the two business models,” stated Dr. Kevin Saluck, senior director of contracting and governmental affairs.  It was exhibited to Ms. Fefferman that when attempting to align Medicare pricing with market prices, much more needs to be considered than just the acquisition cost of the product itself.   

“Ms. Fefferman learned that our industry provides essential patient services that reduce overall costs in the health care continuum, and that we do not just sell a commodity in a box.  I believe this experience was such an eye opener for her that she is going to encourage Senator Menendez to visit our location as well,” said Richard Lerner, Allcare Medical president. 

A power mobility patient was present to discuss how Allcare Medical has helped her over the past decade, and she successfully articulated her first-hand experience with buying a power chair at a lower price from the internet.  This turned out to be a “penny-wise, pound-foolish” decision for this client, as without the assessment of an ATP, the chair was clinically inappropriate for her condition.  Today the chair sits in a closet in her home - unused.

“I believe Ms. Fefferman’s visit to Allcare Medical today will be of mutual benefit to New Jersey Medicare beneficiaries and to our industry,” said Wendy Russalesi, JAMES executive director.   “It was our goal to educate Ms. Fefferman on the HME industry, and also to highlight how the requirements of maintaining a valid Medicare enrollment status significantly impacts overhead costs.” 

The Jersey Association of Medical Equipment Services (JAMES), established in 1978, disseminates information related to the delivery of Home Medical Equipment to providers of these services. It is the goal of the organization to keep its members informed of industry changes and related information necessary to maintain quality of care in providing home medical equipment, supplies and services to the patients who rely on us.  Our membership is comprised of more than 70 members and manufacturers doing business in the state of New Jersey.  For more information, please visit www.jamesofnj.org or contact us by phone at 732-503-5665.

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From VGM Group, September 29, 2010

167 auction experts/economists worldwide have joined to say that CMS’ competitive bidding program for DME is flawed.  In a letter dated Sept. 26 and addressed to Ways and Means Health Subcommittee Chairman Pete Stark (D-Calif.), the economists cite four main problems with the program. 

The Jersey Association of Medical Equipment Services has developed a full-color brochure, titled "Medicare Competitive Bidding:  What It Means for New Jersey Medicare Beneficiaries" for our members to distribute to their Medicare clients.  This brochure is available as a benefit of JAMES membership!

The competitive bidding program is slated to encompass 80 percent of New Jersey, and the processes for this program will be initiated by the spring of 2011 for Round 2 MSAs (Metropolitan Statistical Areas).

For a preview of the brochure and the brochure request form, please refer to JAMES Electronic Alert Vol. 3, No, 46.  

 Allcare Medical Testifies for the Home Medical Equipment Industry at Energy and Commerce Hearing on Competitive Bidding

Karen Lerner, RN, MSN, ATP, CSW, testified on behalf of the home medical equipment industry today before the Subcommittee on Health, House Committee on Energy and Commerce.  Allcare Medical was the only witness invited to testify that represented the HME industry.

"With respect to all of the promised savings and advantages of the "competitive" bidding program, I maintain that what sounds too good to be true, is too good to be true.  This ill-conceived program will single-handedly destroy the home medical services sector, harm the patients we serve and ultimately increase Medicare costs", Ms. Lerner testified. 

The written testimony submitted by Ms. Lerner was fourteen pages in length, and focused on topics such as the clinical perspective of competitive bidding, the impact on beneficiary quality and access to care and the flaws of the structure of the program.

The other six witnesses selected to testify at today's hearing included representatives from the Centers for Medicare & Medicaid Services (CMS), the Office of the Inspector General (OIG), the Government Accountability Office (GAO), the Center for Medicare Advocacy,  the Henry Ford Health System and a health policy consultant.

To view all written testimony and a video stream of the hearing, please visit the Committee on Energy and Commerce website.

The New Jersey State Board of Respiratory Care issued proposal number PRN 2010-103 on July 6, 2010.

The full summary of the proposed changes appear on the New Jersey Division of Consumer Affairs webpage.  

Public comments on the proposed changes are being accepted until September 4, 2010. 

Public comments may be submitted electronically through the New Jersey Division of Consumer Affairs webpage, or in writing.

Home medical equipment could become harder to get
Saturday, July 31, 2010
SPECIAL TO THE TIMES

In recent years, policymakers in Washington, D.C., have been trying to cut health-care costs, especially in Medicare, the federal health-care program or senior citizens and people with disabilities. The spending cuts and reforms have left many of New Jersey's 1.3 million Medicare beneficiaries wondering: "What does this mean for me?"

For many of New Jersey's Medicare beneficiaries and their families, what it will likely mean is that it will be harder to get access to the home medical equipment and services they need to stay healthy and independent in their own homes -- and out of a nursing home or hospital.

Even though spending on home medical equipment is less than 2 percent of the total Medicare budget, and even though reimbursement rates have been cut deeply and disproportionately over the years, Washington bureaucrats are attempting to squeeze even more out of this small, cost-effective sector.

One of the most troubling and misleading schemes scheduled to take effect soon is the Medicare "competitive" bidding program for home medical equipment and services, which includes oxygen therapy, wheelchairs, hospital beds and other durable medical equipment used at home.

This bidding program is designed to eliminate most of the home medical
equipment providers in the U.S., even if they bid low to provide home
medical equipment and services. That became clear when the program was first implemented in 2008, in 10 areas around the U.S. Congress halted the program due to numerous problems and flaws, such as Medicare contracts awarded to unlicensed home medical providers. However, in re-implementing the bidding system, the Medicare program did not make the changes needed to protect homecare patients and providers.

As it stands, the Medicare bidding program encourages "suicide bidding."
Because Medicare is the primary payer for senior citizens and people with disabilities who use home medical equipment, Medicare can use economic coercion to force home care providers to submit to unsustainably low bids needed to "win" one of the few contracts offered. In the end, this Medicare bidding scheme will actually discourage competition in the home medical equipment and services sector, reduce access to care for patients and put hundreds of New Jersey providers out of business. The bidding process is complete in nine metropolitan statistical areas in the U.S., and that same process begins in 2011 in three regions that cover 80 percent of New Jersey.

The sad irony is that this misguided program will actually increase costs
over the long run. With fewer available providers of home care equipment and services, many patients will be forced into far more expensive post-acute care alternatives, such as hospitals or nursing homes, which will simply shift costs to other parts of the health-care system.

When it comes to caring for patients in the home, there is no need for a
tradeoff between quality and affordable care. Home care is both
cost-effective and the preferred method of care by senior citizens and
patients because it provides them with independence and allows the
opportunity to be close to family and friends. The more patients rely on
quality health-care equipment and services at home, the less the U.S. will have to spend on longer hospital stays, emergency room visits and nursing home admissions.

Providers of home medical equipment and services across New Jersey are proposing a more fiscally responsible alternative to the "competitive"
bidding scheme. The Jersey Association of Medical Equipment Services and hundreds of local providers of home care equipment and services proudly support H.R. 3790, a bipartisan bill in Congress that would preserve access to home care and provide a cost-effective alternative to the misguided Medicare "competitive" bidding program for durable medical equipment. So far, the bill has 252 cosponsors in the U.S. House of Representatives, with broad bipartisan support. More than half of the New Jersey delegation in the U.S. House of Representatives are co-sponsoring the bill.

H.R. 3790 would replace the troubled bidding program while ensuring that the projected cost savings of the program are met through a series of payment reductions for home medical equipment providers across the country. This important bipartisan bill will preserve high-quality home care services and equipment for New Jersey patients and prevent the needless closing of businesses across New Jersey during an already difficult economy.

The New Jersey Medicare population should be gravely concerned about the bidding scheme, which will delay access to necessary medical equipment, reduce the quality of the medical equipment provided and place additional economic strain on the state's small business community.

Wendy Russalesi is executive director of the Jersey Association of Medical Equipment Services.

The Times of Trenton, July 31, 2010

CONTACTS:

Wendy Russalesi, 732-503-5665, Jersey Assn. of Medical Equipment Services, wrussalesi@jamesofnj.org; 

Michael Reinemer, 703-535-1881, American Assn. for Homecare, michaelr@aahomecare.org. 

New Jersey’s Seniors Will Pay Steep Price for Medicare’s
“Competitive” Bidding Program for Home Medical Equipment

JACKSON, NJ, July 27, 2010 ------ Seniors and people with disabilities who rely on home medical equipment and services in New Jersey will pay a steep price under Medicare’s controversial and mislabeled “competitive” bidding program for durable medical equipment.  With the recent passage of the health reform bill, this program is now slated to encompass 80 percent of New Jersey during the second round of bidding.

The U.S. Department of Health and Human Services announced recently that bidding in nine of the country’s largest metropolitan areas could save Medicare as much as $17 billion over 10 years for home medical equipment and services. But those alleged savings are the result of “suicide bids” from providers in an ill-advised race to the bottom that will put thousands of homecare providers out of business and reduce patients’ access to care. Recognizing that the program is bad healthcare policy, a bipartisan group of 254 lawmakers in the House of Representatives support legislation that would repeal the bidding program but preserve the projected cost savings for Medicare.

“New Jersey’s Medicare population should be gravely concerned about this bidding program,” says Wendy Russalesi, executive director of the Jersey Association of Medical Equipment Services (JAMES), which represents providers of home medical equipment in the state. “This program will do nothing more than delay access to necessary medical equipment, reduce the quality of the medical equipment provided, and place additional economic strain on the small business community of New Jersey.”

The Medicare bidding program uses economic coercion to force homecare providers to submit unsustainable bids necessary to win a contract. Because Medicare is the largest third-party purchaser of home medical care, its market power effectively coerces providers to bid at unsustainable reimbursement rates to ensure the opportunity to continue serving Medicare beneficiaries. Ultimately, the below-market rates achieved through this bidding program will force thousands of businesses to close, reducing competition in the long term and reducing seniors’ access to care and choice of providers.

Congress delayed the implementation of this bidding program in 2008 to allow for needed changes, and the home medical equipment sector paid for that delay by taking a 9.5 percent nationwide reimbursement cut to pay for the projected savings from the initial round of the program. However, the Centers for Medicare and Medicaid Services (CMS) ignored congressional intent, did not address the flaws that precipitated the delay two years ago, and is now recklessly charging forward with the program in nine of the 10 largest metropolitan statistical areas in the U.S.  An additional 91 areas will be subjected to the bidding process next year.

“CMS is working on the flawed concept that this will save the money for beneficiaries and CMS,” said Dr. Kevin Saluck, vice president of clinical operations at Sayreville, N.J.-based Allcare Medical, and president of JAMES. “This will prove to be untrue as the average length of stay in hospitals will inevitably increase, as will hospital readmissions, thanks to problems caused by a decrease in the number of home medical equipment suppliers.  Patients and families don’t want longer hospital stays, and our Medicare system can’t afford them.”

“There is so much more to taking care of Medicare beneficiaries than the price of the item,” added Raymond Arthurs, owner of First Care Medical Supplies in Manalapan, and Vice President of JAMES. “We all know these extensive service, overhead and compliance expenses very well – and so does CMS – but they fail to recognize them even though they created many of these costs themselves.”

A broad group of 254 members of the House of Representatives has cosponsored legislation in Congress, H.R. 3790, to stop the bidding program and replace it with a fiscally responsible measure to reduce payment rates for homecare but preserve the ability of home medical providers to continue serving Medicare beneficiaries.  New Jersey Representatives who have cosponsored the bill include Robert Andrews (D), Rodney Frelinghuysen (R), Leonard Lance (R), Frank LoBiondo (R), Donald Payne (D), Steven Rothman (D), Albio Sires (D), and Chris Smith (R).  

Other organizations that support the elimination of Medicare’s bidding program for home medical equipment include the ALS Association, the American Association for Respiratory Care, the American Association of People with Disabilities, International Ventilator Users Network, the Muscular Dystrophy Association, National Emphysema/COPD Association, National Spinal Cord Injury Association, Post-Polio Health International, and United Spinal Association, among others.

Unintended negative consequences of the bidding program include:

• REDUCED ACCESS TO CARE AND SERVICE DISRUPTION – This bidding program will restrict consumer access to care and choice for home medical items and services, and it will trigger a race to the bottom in terms of quality. Less expensive items will be provided to patients. The program will disrupt the continuum and coordination of care between doctors, discharge planners, patients, and home medical equipment providers. With a loss of providers, expedient deliveries of items and services will be eliminated.

• HIGHER SPENDING IN MEDICARE – The bidding program will increase Medicare costs. It will lead to longer, more expensive hospital stays and more physician office visits, nursing home admissions, and emergency room visits.

• LESS COMPETITION, NOT MORE – The bid program is anti-competitive because it reduces the number of competitors.  About 90 percent of home medical service providers would have been barred from the Medicare program in the first round of bidding conducted in 2008.

• LOSS OF JOBS AND SMALL BUSINESSES – The bidding program will result in the closing of thousands of small businesses and result in as many as 100,000 job losses nationwide.

The Jersey Association of Medical Equipment Services (JAMES), established in 1978, disseminates information related to the delivery of Home Medical Equipment to providers of these services. It is the goal of the organization to keep its members informed of industry changes and related information necessary to maintain quality of care in providing home medical equipment, supplies and services to the patients who rely on home medical equipment.  JAMES membership is comprised of more than 70 members and manufacturers doing business in the state of New Jersey.  Visit www.jamesofnj.org or call 732-503-5665.

The Centers for Medicare & Medicaid Services issued a press release today related to the PECOS enrollment. 

CMS 6010 IFC allows the public to submit comments from May 5 through July 6, 2010.  We encourage our members to submit comments electronically.  This rule establishes that physicians must have a valid PECOS enrollment by July 6, 2010. 

JAMES members should refer to Electronic Alert Vol. 3, No. 32 for specific instructions on submitting your electronic comment. 

Wendy Russalesi, 732-503-5665, Jersey Assn. of Medical Equipment Services, wrussalesi@jamesofnj.org; 

Michael Reinemer, American Assn. for Homecare, 703-535-1881, michaelr@aahomecare.org;

Alissa Hinkson, alissahinkson@rational360.com, Rational 360, 202-470-5340  

New Jersey Home Medical Equipment Providers Call on Congress to Preserve Homecare as an Option for Seniors and People with Disabilities

Jackson, NJ, June 1, 2010 ------ Providers of home medical equipment and services across New Jersey are proposing a fiscally responsible alternative to the mislabeled “competitive” bidding scheme currently under way in Medicare that will actually discourage competition, reduce access to care for many of the state’s 1.3 million Medicare beneficiaries, and put hundreds of New Jersey homecare providers out of business.

“This bidding program is something that New Jersey’s Medicare population should be gravely concerned about,” says Wendy Russalesi, executive director of the Jersey Association of Medical Equipment Services (JAMES), which represents providers of home medical equipment in the state. “If implemented, this program will do nothing more than delay access to necessary medical equipment, reduce the quality of the medical equipment provided, and place additional economic strain on the small business community of New Jersey.  With the recent passage of the health reform bill, this program is now slated to encompass an alarming 80 percent of our state during the second round of bidding.”

The Medicare bidding program encourages “suicide bidding,” using economic coercion by forcing providers to submit unsustainable bids necessary to win a contract. Although Congress delayed the implementation of the selective contracting program in 2008 to allow for needed changes, the Centers for Medicare and Medicaid Services (CMS) ignored congressional intent and did not address the flaws that precipitated the delay.  

“For decades, durable medical equipment providers have competed in an open market on the basis of quality,” says David Ferguson, vice president and general manager of AtHome Medical in Morris Plains, N.J.  “Our differentiating factors have always been the reliability of our products, the timeliness of our service, and the expertise of our clinicians and support staff. What we observed in the 2008 program implementation, which was delayed, was nearly 90 percent of the existing providers were prevented from servicing Medicare beneficiaries.  The provision of care was awarded to some firms with little or no experience servicing the local market and those who had submitted unsustainably low rates, or ‘suicide bids,’ without thought as to the whether they could sustain care, let alone quality care.  In an environment with reduced competition, quality always suffers.”  

The bidding process is now underway in nine metropolitan statistical areas (MSAs) in the U.S., and that process begins in 91 more MSAs next year, including three MSAs that cover 80 percent of New Jersey.  

“With all of the changes the homecare sector has had to absorb over the past several years, our company has had to make some very difficult decisions regarding the services and products we can continue to offer,” states Dr. Kevin Saluck, vice president of clinical operations at Sayreville, N.J.-based Allcare Medical, and president of JAMES.  “CMS has forced us down a one-way street.  At the end of this street, we will be forced to offer lesser quality products, fewer services and unfortunately, a much different business model to our referrals and customers.” 

“Over the course of the last three years, we have increasingly moved away from Medicare business in preparation for this bidding program,” says John Gerity, CEO of Access 2 Care in Lincoln Park, N.J.  “We estimate laying off one-third to one-half of our work force if the bidding program becomes a reality.  Medicare beneficiaries will have less access to quality durable medical equipment companies, many of whom will be closing their doors.”

JAMES supports H.R. 3790, a bipartisan bill in Congress that would preserve access to homecare and provide a cost-effective alternative to a misguided Medicare “competitive” bidding program for durable medical equipment. H.R. 3790 replaces the Medicare bidding program with other types of cost-savings that will reduce reimbursements to home medical equipment providers but preserve patient access to medically required equipment and services in the home.

So far, the bill has 242 cosponsors in the U.S. House of Representatives with broad bipartisan support. More than half of both the Democratic and Republican delegations in the House support the bill.

More than half of the New Jersey delegation in the U.S. House of Representatives have cosponsored the bill: Representatives Robert Andrews, Leonard Lance, Frank LoBiondo, Donald Payne, Steven Rothman, Albio Sires, and Christopher Smith.

Patient and consumer groups that support the elimination of Medicare’s “competitive” bidding program for durable medical equipment include the ALS Association, the American Association for Respiratory Care, the American Association of People with Disabilities, International Ventilator Users Network, the Muscular Dystrophy Association, National Emphysema/COPD Association, National Spinal Cord Injury Association, and Post-Polio Health International, among others.

Proponents of the Medicare bidding program for durable medical equipment have perpetuated several myths about the program. However, the reality is quite different.

MYTH:  The bidding program will be good for Medicare beneficiaries.

REALITY: It will, in fact, reduce access to medically required equipment and services.

MYTH:  The program will eliminate Medicare fraud in the durable medical equipment sector.

REALITY: The solution to fraud is better screening of providers, real-time claims audits, stiffer penalties, and better enforcement mechanisms for Medicare – steps that the home medical providers support.

MYTH: The bidding program helps businesses by creating a more competitive environment.

REALITY:  The program coerces providers to bid at unsustainable Medicare reimbursement rates and will force thousand of businesses to close, reducing competition in the long term.

MYTH: Providers will be competing on quality and price.

REALITY: The bidding program will ration care. Home medical equipment providers already compete on the basis of quality and help move people smoothly from hospitals to cost-effective care at home.

MYTH:  The bidding program will make healthcare more cost-effective.

REALITY: The home is already the most cost-effective setting for post-acute care. As more people receive good equipment and services at home, the U.S. will spend less on longer hospital says, emergency room visits, and nursing home admissions.  

“Homecare is the preferred, cost-effective solution for those recuperating or managing their current diagnosis, and the home medical equipment provider community is an integral part of that solution,” says Russalesi.  “To dismantle that infrastructure, especially at a time when the Baby Boomer generation is entering the Medicare program in such large numbers, would be devastating to our senior population.”

For more details on the bidding program, visit www.aahomecare.org/competitivebidding

The Jersey Association of Medical Equipment Services (JAMES), established in 1978, disseminates information related to the delivery of Home Medical Equipment to providers of these services. It is the goal of the organization to keep its members informed of industry changes and related information necessary to maintain quality of care in providing home medical equipment, supplies and services to the patients who rely on us.  Our membership is comprised of more than 70 members and manufacturers doing business in the state of New Jersey.  For more information, please visit www.jamesofnj.org or contact us by phone at 732-503-5665.

It was announced on the May 19 Open Door Forum call hosted by CMS that DMEPOS providers may begin using Internet-based PECOS as of July 13, 2010. 

Providers and suppliers will be able to submit enrollment applications, view enrollment information, update enrollment information, complete the re-enrollment process, voluntarily terminate from the Medicare program, and track the status of an application submitted via the Internet.

On July 5, 2010, the enrollment data for all active DMEPOS providers will be moved from the National Supplier Clearinghouse (NSC) into the Provider Enrollment, Chain and Ownership System (PECOS). 

JAMES Members - Refer to Electronic Alert, Vol. 3, No. 27 for additional PECOS information.

CMS Getting Started Guide for DMEPOS Suppliers

The Jersey Association of Medical Equipment Services is pleased to announce they will be partnering with the Union Elks Lodge #1583 to accept donations for "Elks Camp Moore".

"Tucked away in the hills of the Ramapo Mountains, Elks Camp Moore offers a fun filled vacation away from home for children with special needs.  The primary goal of the camp is to further develop the recreational and social skills of each child.  In a relaxed and accepting atmosphere, each camper experiences new adventures, lasting friendships, and opportunities that promote independence and greater self-confidence."

Camp Moore has presented JAMES with a Wish List for their Health Center.  You may download the Wish List below.  If you would be willing to donate any of the items on the list to Camp Moore, please contact Tina Padden, JAMES Secretary or Wendy Russalesi, JAMES Executive Director to arrange the delivery of your donation.  Donations are being accepted until June 25, 2010. 

Tina Padden may be reached by dialing 908-403-4294, and Wendy Russalesi may be reached by dialing 732-503-5665.  

Camp Moore Wish List

The JAMES office received confirmation this morning from Representative Chris Smith's  (NJ-R-4) office that he has signed on as a co-sponsor to H.R. 3790 - the legislation that would repeal the competitive bidding program.

As of this morning, there were officially 218 co-sponsors of this legislation.  Representative Smith's commitment will increase the list to 219.  New Jersey now has 53% of our representatives signed on as co-sponsors

Representative Smith joins his fellow colleagues already signed on as co-sponsors of H.R. 3790:

• Robert Andrews
• Leonard Lance
• Frank LoBiondo
• Donald Payne
• Steven Rothman
• Albio Sires

Prepared by the American Association for Homecare:

A Mobility Matters bulletin, released by AAHomecare, documents the case of a 68-year-old amputee from Yucca Valley, Calif, whose Medicare claim for a power wheelchair was denied by the government.  Both his legs had been amputated; after a stroke he had the use of one “good” arm that constantly ached. 

Under Medicare regulations, power wheelchairs are supposed to last at least five years before being replaced, but this patients chair had worn out after three years from heavy use because often his power wheelchair served as both his transportation and his bed. Learn more about his story and the need for substantial changes in the way that Medicare claims for homecare equipment are handled by the Centers for Medicare and Medicaid Services.

Please download the complete press release below:

AAH Press Release: Medicare Denies Wheelchair Claim for Elderly Amputee

NHIC, Corp, the Jurisdiction A DME MAC, has published a letter from all four medical directors that addresses the need for medical documentation to support the continued medical need for DMEPOS items.

The letter can be viewed by clicking the following link:

Durable Medical Equipment - Documentation of Continued Medical Necessity 

H.R. 3790 is budget neutral legislation that would repeal the competitive bidding acquisition program for DMEPOS items.  As of today, there are 182 cosponsors on the legislation.  

Since the lobbying efforts of JAMES in Washington, D.C. on March 2 and 3, New Jersey has gained three additional cosponsors on this legislation.  The association is continuing to follow-up with offices that have yet to sign on as cosponsors.  

The following representatives are currently cosponsoring H.R. 3790, and we thank them for their support:

• Robert Andrews (NJ-1)
• Leonard Lance (NJ-7)
• Frank LoBiondo (NJ-2)
• Donald Payne (NJ-10)
• Steven Rothman (NJ-9)
• Albio Sires (NJ-13)

If your representative is not listed above, we urge you to contact their office and ask for their cosponsorship on H.R. 3790.  Resources to use during your discussions have been emailed to all JAMES member companies.

Jersey Association of Medical Equipment Services

Press Release

CONTACT:    Wendy Russalesi, 732-503-5665, wrussalesi@jamesofnj.org

New Jersey Medical Equipment Suppliers Travel to Washington to Advocate for Better Home Medical Care for Seniors and People with Disabilities

JACKSON, N.J. March 18, 2010 ------ Homecare providers from New Jersey-based home medical equipment companies travelled to Washington, D.C. earlier this month to urge members of Congress to strengthen, not weaken, homecare as an option for the millions of older Americans and people with disabilities who require home-based medical equipment and services.

“Home-based care is by far the most cost-effective setting for post-acute care,” said Wendy Russalesi, Executive Director of the Jersey Association of Medical Equipment Services (JAMES). “Quality home medical equipment and services help to reduce hospitalizations, ER visits, and admission to nursing homes.”

The group met with the state’s Senators, Frank Lautenberg and Robert Menendez, as well as New Jersey Representatives John Adler, Robert Andrews, Rodney Frelinghuysen, Rush Holt, Leonard Lance, Frank LoBiondo, Frank Pallone, Bill Pascrell, Albio Sires and Chris Smith.

New Jersey home medical equipment providers asked members of Congress to support H.R. 3790, a bipartisan bill that would preserve access to homecare and provide a cost-effective alternative to a misguided Medicare “competitive” bidding program for durable medical equipment.  

“This bidding program is actually anti-competitive,” said Russalesi. “It will ultimately put many of the best community-focused providers out of business, eliminating competition in the long run. It also promotes irresponsible ‘suicide bidding’ using economic coercion to force providers to bid at unsustainable reimbursement rates. For providers here in New Jersey, it’s a job killer. Coming on top of the many other reimbursement cuts our sector has suffered, this bid program will reduce services that Medicare beneficiaries need.”

H.R. 3790 would replace the Medicare bidding program with other types of cost-savings and at the same time preserves access to home-based care. The bill currently has 182 cosponsors in the U.S. House of Representatives, with strong bipartisan support that includes roughly equal proportions of Democrats and Republicans as cosponsors.  Congressmen Andrews and Lance became the latest New Jersey legislators to sign onto the bill as a result of the meetings in Washington.  They join New Jersey Representatives LoBiondo, Payne, Rothman and Sires as cosponsors.

Russalesi was among several hundred providers of home medical equipment gathering in Washington at a conference hosted by the American Association for Homecare, which represents providers of home medical equipment and services. 

JAMES is New Jersey’s leader in medical equipment advocacy and education, representing more than 70 member companies serving patients and communities across the state.

Myth vs. Reality

Facts about Medicare’s

“Competitive” Bidding Program for

Homecare Medical Equipment

CMS has been touting the merits of the Medicare competitive bidding program for durable, or home medical equipment and services (HME) with messages to convince lawmakers that this suicide bidding program is good for seniors. Unfortunately, CMS has conveyed misleading information and cherry-picked facts that ignore the realities of what will happen if this program moves forward.

MYTH #1: The bidding program is good for beneficiaries because it will significantly reduce cost-sharing requirements.

REALITY: Patient copayments for home medical equipment have fallen dramatically for many years along with decreasing home medical equipment reimbursement rates.  A bipartisan bill in the House, H.R. 3790, would eliminate the bidding program in a fiscally responsible manner by reducing home medical reimbursements to offset savings that the bid program would have realized. So the effect of that bill, which has 173 cosponsors so far, would be a further reduction in copayments for Medicare patients.  Moreover, most beneficiaries have Medigap policies that cover copayments, so insurance companies will be the primary beneficiary of the lower copayments. More importantly, low copayments come at a great cost in terms of reduced access and service. The bidding program will trigger a race to the bottom in terms of care for seniors and people with disabilities.  The bid program will ultimately increase doctor visits, hospital stays, and nursing home admissions, which in turn will increase copayments and other costs for patients and for Medicare.

MYTH #2: The bidding program will eliminate fraud in the durable medical equipment sector.

REALITY: To characterize the bidding program as an anti-fraud mechanism is extremely misleading. The real solution to keeping criminals out of Medicare is better screening, real-time claims audits, and better enforcement mechanisms for Medicare. The American Association for Homecare has proposed an aggressive 13-point plan to combat fraud (www.aahomecare.org/stopfraud) and many of those provisions are included in two bills in Congress.  The Association endorses Sen. George LeMieux’s anti-fraud legislation, The Prevent Health Care Fraud Act of 2009 (S. 2128), and its companion bill in the House, H.R. 4222.  Also two new requirements that took effect in October 2009 – accreditation and surety bonds for home medical equipment providers – will go far toward eliminating fraud. 

MYTH #3: The bidding program is good for business because it creates a more competitive environment.  

REALITY: The program requires “suicide bidding” that coerces providers to bid at unsustainable Medicare reimbursement rates.  At a time when the government is working to create jobs, the bidding pogrom is a job killer. In the first round of the program in 2008, 90 percent of qualified providers were barred from serving Medicare beneficiaries for the bid-upon items, even if they had agreed to the lower Medicare rates.

MYTH #4: Providers will be competing on quality and price.

REALITY: The “competitive” bidding program will, in fact, ration care. Home medical equipment providers already compete on the basis of quality in order to help in the hospital discharge process, which moves patients into cost-effective, post-acute care at home. The way this bidding program is set up triggers a race to the bottom in terms of quality and because losing the bid means going out of business, providers must engage in suicide bidding that coerces them to bid at economically unsustainable rates.  This will increase Medicare spending in hospitals and ER visits.

MYTH #5: The bidding program will make healthcare more cost-effective.

REALITY: The home is already the most cost-effective setting for post-acute care. As more people receive good equipment and services at home, we will spend less on longer hospital says, emergency room visits, and nursing home admissions.  Home medical equipment is an important part of the solution to the nation’s healthcare funding crisis. Home medical equipment represents less than two percent of Medicare spending. So while this bidding program may further reduce reimbursement rates for home medical equipment, ultimately, it will increase Medicare and Medicaid spending for hospitals, physicians, nursing homes, and emergency treatments.

Prepared by the American Association for Homecare, March 10, 2010.

Currently, there are two key pieces of legislation affecting our membership.  H.R. 2373 seeks to restore oxygen payments through the Medicare beneficiary's period of need.  H.R. 3790 seeks to repeal the competitive bidding acquisition program for durable medical equipment, prosthetics, orthotics and supplies (DMEPOS) in a budget neutral manner.

There are 82 co-sponsors on H.R. 2373 and 145 co-sponsors on H.R. 3790.  Representatives Frelinghuysen (R-NJ-11), LoBiondo (R-NJ-2), Rothman (D-NJ-9) and Smith (R-NJ-4) have offered support on H.R. 2373.  Representatives LoBiondo (R-NJ-2), Payne (D-NJ-10), and Rothman (D-NJ-9) have offered support on H.R. 3790.  If your representative is listed as a co-sponsor, please send a thank you to them.  If your representative is not listed as a co-sponsor, please contact their office to ask for their support. 

You may locate your member of Congress and their contact information by logging onto www.congress.org.

JAMES will be attending the American Association for Homecare Legislative Conference in Washington, D.C., March 1 - 3, 2010.  JAMES currently has confirmed appointments with Senators Lautenberg and Menendez, as well as several members of the House of Representatives.  Members - please check your Electronic Alert emails for a detailed schedule.

H.R. 2373 Bill Language

H.R. 3790 Bill Language

All JAMES members must renew your 2010 membership today to avoid the suspension of email Alerts and membership benefits.  

Please call the JAMES office today at 732.503.5665 if you have not renewed your membership!

Jim Bossenmyer, director of the Division of Provider/Supplier Enrollment of CMS, announced on a Special Open Door Forum teleconference on February 17, 2010, that implementation of CR 6417 and CR 6421, will be delayed until January 3, 2011.

DMEPOS claims that were ordered or referred by a physician or non-physician provider type that was not enrolled in PECOS were going to begin rejecting on April 5, 2010.  The new date for this to occur is now January 3, 2011.

While the additional delay to phase 2 implementation is significantly greater than the original delay of 90 days, CMS representatives on the February 17 Special Open Door Forum teleconference recommend that physicians and non-physician provider types that have yet to enroll in PECOS begin the process now, or at least within the next month.

This action should ensure that they are accurately enrolled in PECOS by the new implementation date for phase 2. 

An overview of the PECOS requirement can be found by logging onto the CMS website.

The JAMES Board of Directors is supporting the third round of efforts to gain co-sponsorship of HR 3790 by the National Associaton of Independent Medical Equipment Suppliers (NAIMES).  This legislation was introduced by Kendrick Meek (D-FL-17) and will seek to repeal the competitive bidding program.  Previous efforts to gain co-sponsorship on this bill have included VGM's "Shut Down the Switchboard" and the American Association for Homecare's "Meek Week".

There are currently 140 co-sponsors on the legislation and the industry is seeking a minimum of 218 co-sponsors.  There are three representatives from the New Jersey delegation currently co-sponsoring HR 3790.  We would like to thank Representatives  Frank LoBiondo (R-NJ-2), Donald Payne (D-NJ-10) and Steven Rothman (D-NJ-9) for their support on HR 3790.

SOS Week is running from February 12 - 22, 2010.  Please call your Representative between these dates and ask for their co-sponsorship of HR 3790. Try to reach them in the local district office during the President's Day Recess by visiting them at their office or inviting them to your business.  JAMES can offer assistance in developing the agenda for your site visit!

After reaching out to the local office of your Representative, also contact the Health Legislative Aid in the Washington, D.C. office.  Contact information for both the local and Washington, D.C. office of your representative can be obtained by logging onto Congress.org.

Complete details for SOS Week can be found by clicking here.  Please be sure to contact the JAMES office at 732.503.5665 if you require any assistance and to keep us informed of your progress with your individual member of Congress.

State Associations such as JAMES are working together through the American Association for Homecare's State Leaders Council to gather information to share with CMS regarding PECOS edit warnings.  

The Council has created a survey with a brief explanation asking HME companies to provide the percentage of cliams with the edit warning (PECOS).  This survey was originally developed by the Region A Council, but has been expanded nationwide.

An electronic link to the survey has been provided to JAMES members in the JAMES Electronic Alert Vol. 3, No. 6, dated January 29, 2010.  Please check your email inbox! This survey needs to completed by the close of business on Friday, February 5, 2010.

 JAMES “Help for Haiti” Produces an Impressive Outpouring of Support

Approximately $100,000 in medical equipment and supplies collected for donation

JACKSON, NJ, January 29, 2010 -  Raymond Arthurs, vice president of JAMES and owner of First Care Medical Supplies, worked together with JAMES executive director, Wendy Russalesi, to collect approximately $100,000 in donated medical supplies and equipment from its membership.  The medical supplies and equipment will be donated to aid the victims of the earthquake that struck Haiti on January 12, 2010.

“I was watching the news about the Haiti earthquake aftermath and Julia, my eight year old daughter said to me, ‘Daddy, you have to help these people.’  That was enough to set the wheels in motion,” said Raymond Arthurs.  Ray contacted the JAMES Board of Directors, who agreed that the association should do their part to contribute.  “Even though the association mostly consists of independent medical equipment providers who, like any business, face uncertain economic times, I felt it was important that the membership band together to help those who are less fortunate than us,” said Dr. Kevin Saluck, president of JAMES.  JAMES reached out to its membership through fax, e-mail and website communications to let members know the details of “Help for Haiti” and how they could participate.

The Marlboro, NJ location of Secure Self Storage provided a drop-off location for JAMES members to bring their donations to.  First Care Medical Supplies of Manalapan, NJ, provided vehicles and staff that did pick-ups of donations at JAMES member locations throughout the state of New Jersey.

“To collect the amount of medical equipment and supplies that our association did in such a short period of time displays a remarkable humanitarian commitment from our membership,” said Wendy Russalesi.

The medical equipment and supplies were delivered to Marcy Sasso, director of operations at the Ambulatory Surgical Center of Union County on Tuesday, January 26, 2010.  Ms. Sasso is coordinating with NJ 4 Haiti to transport the medical supplies and equipment to Haiti.

The Jersey Association of Medical Equipment Services (JAMES), established in 1978, disseminates information related to the delivery of Home Medical Equipment to providers of these services. It is the goal of the organization to keep its members informed of industry changes and related information necessary to maintain quality of care in providing home medical equipment, supplies and services to the patients who rely on us.  Our membership is comprised of more than 70 members and manufacturers doing business in the state of New Jersey.  For more information, please visit www.jamesofnj.org or contact us by phone at 732-503-5665.

###

The JAMES Board of Directors would like to request the assistance of our member companies in helping the people of Haiti in their desperate time of need.

At the top of the list of necessary items for the recovery efforts are medical supplies and non-perishable food items, including bottled water.

According to news reports, the most needed medical supplies are gauze, bandages and IV supplies.  Also according to news reports, the most ocmmon injuries after a natural disaster of this type are amputations and bone fractures.  For this reason, donations of mobility enhancing equipment would be necessary as well.

Raymond Arthurs of First Care Medical Supplies, Vice President of JAMES, is coordinating efforts with the JAMES Board of Directors to pick up donations at JAMES member company locations. 

Here is what we are asking from our members:

• Provide JAMES with a detailed inventory, including quantities, of what your company is donating

• Contact the JAMES office beginning today and throughout the weekend by fax or email with your inventory list

• Provide the complete physical address of where your supplies are located for pick up, as well as the phone number, contact name and hours of operation

• Have supplies available for pick up beginning Monday, January 18, 2010.

The JAMES office will contact your company to advise when your pick up has been scheduled.  Donations will be delivered for our member companies on Tuesday, January 26, 2010, to the Ambulatory Surgical Center of Union County.  This facility is coordinating with NJ 4 Haiti to transport the medical equipment and supplies to Haiti.

 JAMES Facilitates Legislative Visit to a New Jersey HME Site at the Request of Representative Frank Pallone’s Office

Extended visit focused on the value of homecare 

JACKSON, NJ, January 7, 2010 -  Tiffany Guarascio, Legislative Director for Representative Frank Pallone’s Washington, D.C. office contacted the Jersey Association of Medical Equipment Services, and expressed interest in visiting a home medical equipment (HME) provider in their district.  JAMES general member, Allcare Medical, hosted the educational site visit at their corporate headquarters located in Sayreville, New Jersey.  Allcare Medical is a full service HME provider, with a scope of service that includes respiratory equipment and supplies, power mobility and custom rehab products, and orthotics and prosthetics. 

Originally scheduled for a two-hour visit, Ms. Guarascio extended her time at Allcare Medical to well beyond three hours.  Ms. Guarascio received an extensive tour of Allcare Medical that included a visit to their retail site, distribution warehouse and corporate offices.  During this time, Ms. Guarascio met with staff at all levels in the operations of Allcare Medical, each one taking the time to detail their role within the organization and answer Ms. Guarascio’s questions.  Ms. Guarascio was able to understand the flow of operations and experience the efforts that are required to service an HME patient from the initial receipt of an order, all the way through to any follow-up maintenance and services that the patient may require.  Allcare Medical staff was able to accurately detail the measures that are taken by the organization to ensure they are meeting compliance with the CMS Quality Standards, the DMEPOS Supplier Standards and the standards of their accrediting body, as well as all state and federal guidelines that are applicable to their operations.  Most importantly, they were able to help Ms. Guarascio understand all of the transparent services that are not separately reimbursable, but are a necessity for the delivery of a durable product.  It was evident to Ms. Guarascio that an HME provider is an integral part of helping to keep the patient in their preferred home setting while they recuperate or manage their medical condition. 

“I felt we had a very productive meeting with Tiffany Guarascio, Frank Pallone’s Legislative Director.  She seemed very interested during our tour and round-table discussion, and asked many very good questions.  In our discussion session, we had a dozen of our key managers and clinicians introduce themselves and discuss their position within our organization.  We were able to show Tiffany that many professionals, clinicians and staff are required - and the cost to the organization - to provide care and services to the Medicare beneficiary,” said Richard Lerner, Allcare Medical President. 

Also during the round-table session of the visit, the concerns of the industry regarding the competitive bidding program, the current 36-month oxygen cap and the preservation of the first month purchase option for power mobility were discussed with Ms. Guarascio.   A power mobility patient was present to discuss how Allcare Medical has helped her over the past decade, and phone testimonials were provided to the group by two long-term respiratory patients.

Dr. Kevin Saluck, Vice President of Clinical Operations for Allcare Medical and JAMES President stated, “During the discussion of the complexities of the 36-month oxygen cap, Ms. Guarascio was taken aback by the fact that we are expected to supply oxygen and services to Medicare beneficiaries that travel, and that we have no representation in the state that the beneficiary travels to.”

“I believe Ms. Guarascio was given an essential education in the necessary role that our member companies play in the value of homecare. The costs involved with providing the level of service that our industry’s regulations have placed on an HME provider – costs that have gone as unrecognized by our policymakers - were largely on display for Ms. Guarascio.  It was apparent during this site visit that there is a significant focus by the HME provider on providing timely access to quality home medical equipment and services,” said Wendy Russalesi, JAMES Executive Director.

The Jersey Association of Medical Equipment Services (JAMES), established in 1978, disseminates information related to the delivery of Home Medical Equipment to providers of these services. It is the goal of the organization to keep its members informed of industry changes and related information necessary to maintain quality of care in providing home medical equipment, supplies and services to the patients who rely on us.  Our membership is comprised of more than 70 members and manufacturers doing business in the state of New Jersey.  For more information, please visit www.jamesofnj.org or contact us by phone at 732-503-5665.

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This is “Meek Week” – an ideal time to meet with your members of Congress while they are back in their home districts and ask them to support Rep. Kendrick Meek’s bill, H.R. 3790, to eliminate the “competitive” bidding program. By drastically cutting reimbursement rates and number of home medical equipment firms allowed to participate in Medicare, the bidding program promises to cripple the nation’s homecare sector – the most affordable, cost-effective form of health care available to Americans.

Later this week, a JAMES member company in Representative Pallone's district will be hosting an educational visit for Mr. Pallone's Legislative Director from the Washington, D.C. office.  The opportunity will be used to provide education about the HME industry, and the value our industry adds to homecare. 

Jersey Association of Medical Equipment Services Elects New Executive Board, Fills Board Vacancies

Press Release – November 30, 2009

Jackson, NJ - On November 19, 2009, at the JAMES Annual Conference, "The Tides of Change", a new Executive Board of Directors was elected.  Elections were also held to fill expired board positions, as well as board vacancies.

Elected to our Executive Board of Directors:

Dr. Kevin Saluck, President, Allcare Medical

Raymond Arthurs, Vice President, First Care Medical Supplies

Tina Padden, Secretary, Community Surgical Supply

Ben Hertz, Treasurer, Elmora Pharmacy

Elected to our Board of Directors:

Josh Parnes, Ocean Home Health

Seth Auerbach, Komfort & Kare

Vikram Patel, DeRosa Pharmacy

Jeffrey Reses, Lincoln Medical

Elected as our Associate Board of Director:

 Gary Brown, Invacare

Bob Miller of Bach's Home Health Care and Ron Manno of Core Care Technologies are also serving in current terms of office on the Board of Directors.

Elections will be held at our 2009 Annual Conference, "The Tides of Change", on November 19, 2009. 

At this time, there are four board positions that will need to be filled, and the terms of the Executive Board are expiring.  If you are interested in serving on the JAMES Board of Directors and your company is a JAMES General Member, please complete the nominating ballot available for download below.

The ballot must be returned by fax to the JAMES office by November 5, 2009.  The fax number is 732.833.2029.

If you would like information regarding the responsibilities of being a JAMES Board Member, please contact the JAMES office at 732.503.5665.

JAMES 2009 Nominating Ballot

This week, H.R. 3790 was introduced by Congressman Kendrick Meek (D-FL).  This is a budget neutral, bi-partisan bill that would repeal the DMEPOS Bidding Program.

While New Jersey is not in any of the Round One MSA's of the DMEPOS Bidding Program, it is in Round Two.  There is the very real potential that 13 out of New Jersey's 21 counties will be affected by this program.  

The JAMES Board of Directors realizes the devastating affects that this program will have on New Jersey and is asking all JAMES member companies to contact their legislators to co-sponsor H.R. 3790.

As of December 9, 2009, there are 97 co-sponsors signed onto H.R. 3790.  Representative Frank LoBiondo (R-NJ-2), Representative Steven Rothman (D-NJ-9) and Representative Donald Payne (D-NJ-10) have signed onto this legislation as co-sponsors.

Please continue to urge your representatives to support this legislation! 

H.R. 3790 Summary Page

Join JAMES by October 1, and sample the full benefits of General Membership for only $250 for the remainder of 2009!

There are numerous advantages to supporting your state association as a General Member, some of them highlighted below:

                                         General Membership

• Annual Conferences and Educational Seminars - Reduced Rates
• Participation in the American Association of Homecare's State Leaders Council, Medicare Jurisdiction A Council, and the Medicare Provider and Outreach and Advisory Group
• Legislative Assistance and Representation
• Medicare and Medicaid Intermediary
• Electronic Alerts - an emailed publication that alerts you to the most up-to-date industry information
• Members Only Area access on our website - use the forums to discuss current events and issues within the industry with other members, view meeting minutes and archived information
•  Access to JAMES General Counsel, David Barmak, Esq., at a reduced hourly rate

The JAMES Board of Directors invites you to complete an application for General Membership prior to October 1, 2009, and we will pro-rate your dues to the rate of $250!  Your company will receive the full benefits of membership, and you will qualify to receive the JAMES Member Rate at our upcoming 2009 Annual Conference, scheduled for November 18 - 19, 2009.

JAMES Membership Application

JAMES Membership Drive

JAMES Credit Card Authorization

On Monday, July 13, 2009, Dr. Kevin Saluck, JAMES Vice President attended Congressman Rush Holt's healthcare reform round-table discussion.  JAMES was chosen by Congressman Holt to represent the medical device/equipment stakeholders. 

Congressman Holt is a representative on the House Tri-Committee for healthcare reform.  The expectation is that the House will pass this bill by the end of July.  It is the highest priority of the President to pass a $900 billion healthcare reform by the end of this year.

As of July 23, 2009, there are 74 co-sponsors signed onto HR 2373.  Representatives from NJ that have signed on are:

Rodney Frelinghuysen (D-NJ 11), Christopher Smith (D-NJ 4),Steven Rothman (D-NJ 9), Frank LoBiondo (R-NJ2)

Through the efforts of the North Carolina Association for Medical Equipment Services (NCAMES) and the Georgia Association of Medical Equipment Services (GAMES), the Home Oxygen Patient Protection (HOPP) Act of 2009, H.R. 2373, was introduced in the House on Tuesday evening.  The legislation is sponsored by Rep. Heath Shuler (D-NC) and Rep. Tom Price (R-GA).  This will repeal the cap on home oxygen therapy that was enacted as part of the Deficit Reduction Act of 2005.  Price introduced a similar bill in the 110th Congress, H.R. 621, which attracted 143 cosponsors. 

Democratic legislators should contact the office of Rep. Heath Schuler (D-NC) and Republican legislators should contact the office of Rep. Tom Price (R-GA) to become a cosponsor on this legislation.

Please contact the JAMES office if you require any assistance or need talking points for HR 2373.

HR 2373 Press Release NC GA

HR 2373 Bill Language

We would like put out a reminder that our courtesy forwards to our new phone number, fax number and mailing address have ceased.  Please check your records to ensure that you are using the current JAMES contact information:

• Phone Number:  732.503.5665
• Fax Number:       732.833.2029
• Mailing Address:  PO Box 38,  Jackson, NJ  08527
• Email Address:  info@jamesofnj.org

JAMES representatives will be attending the American Association for Homecare's Legislative Conference, June 1 - 3, 2009.  The JAMES office will be working to schedule lobbying appointments for June 3, 2009. 

If your company will be attending this conference, please contact the JAMES office at 732.503.5665 so that we may coordinate our appointment schedules for June 3, 2009.

If your company will not be able to be present in Washington, D.C. on June 3, 2009, we urge you to follow-up with your local legislative office here in NJ on that date.  Contact information can be found for the local offices by logging on to http://www.congress.org/.

JAMES 2009 Washington DC Legislative Contacts

The following Congressmen from New Jersey have signed onto the Dear Colleague Letter in support of rescinding the competitive bidding program:

• Christopher Smith
• John Adler
• Albio Sires
• Frank LoBiondo

Please follow-up with your contacts in these offices to thank them for their support.

The deadline to have your congressperson sign onto the Dear Colleague letter initiated by Congresswoman Betty Sutton has been extended to 12 noon on Tuesday, April 14, 2009.

This letter urges CMS and the White House to rescind the competitive bidding interim final rule that is to take effect on April 18, 2009.

House Dear Colleague and Sign-On Letter to Rescind Competitive Bidding April 2009

The JAMES Board of Directors would like to thank everyone who attended the "Medicare & Medicaid Billing Day" on April 2, 2009.

Due to the large number of attendees at the program, we want to be sure that everyone was able to get the assistance that they needed from the representatives that were on-site that day. 

If you still have a situation that needs resolution or have a question that needs to be answered, please contact the appropriate JAMES representative:

• Medicare Committee Chairperson:  Tina Padden
• Medicaid Committee Chairperson:  Ben Hertz
• Medicaid Committee Co-Chairperson:  Bob Miller

You can email Tina, Ben or Bob by navigating to the Contact Us page on this site.

Please feel free to contact the JAMES office at 732.503.5665 if you need additional assistance.

The JAMES Board of Directors would like to remind you of the importance of scheduling an appointment with your local legislative district office between the dates of April 6, 2009 - April 17, 2009. 

Please contact the JAMES office at 732.503.5665 if you need assistance in locating the contact information of your corresponding district office, with scheduling an appointment or with talking points to use for discussion during your appointment.

The surety bond requirement is now a reality and the JAMES Board of Directors is pleased to announce that we have partnered with VGM Insurance to offer our members the opportunity to purchase a low cost surety bond. 

Please contact the JAMES office via phone or email for information on how to ensure you receive the appopriate rate before applying for your surety bond!

JAMES Office - 732.503.5665

The JAMES Board of Directors is pleased to announce that the association will now be offering installment options for General Membership Dues. 

Your company can choose between semi-annual payments or quarterly installments.  Please contact the JAMES office at 732.503.5665 for additional details.

The Jersey Association of Medical Equipment Services (JAMES) is now announcing that its physical transition is complete and has a new address, phone and fax number.

The JAMES Board of Directors is pleased to announce that the association is now offering installment payments and a reduced deposit for all new companies applying for JAMES membership. 

Please download the 2009 Membership Drive information sheet for more details!

JAMES 2009 Membership Drive

The JAMES Board of Directors is pleased to announce that Mr. Bob Miller and Mr. Ron Manno have both been unanimously re-elected to three-year Board of Director positions. 

Congratulations to Mr. Miller and Mr. Manno!