Spina Bifida Association of Northwest Ohio

Courtesy of the Spina Bifida Association. 

Washington, D.C. - On April 1, 2008, the Centers for Medicare and
Medicaid Services (CMS) changed its reimbursement policy on
intermittent catheterization. The previous policy allowed reimbursement for only one
intermittent catheter per week unless an individual user could prove
the existence of at least 2 urinary tract infections in the course of one
calendar year. The revised policy now allows reimbursement for up to
200 catheters per month per individual which means no re-use.

This change was advocated for by medical equipment companies, health
organizations, and universities which saw the manufacturer's term
"single-use" to mean that the sterile catheter should be used one time
and then discarded, not thoroughly cleaned for further catheterization
use which is what many users were forced to do. 

Among the advocates for change were Hollister Incorporated and the
Coloplast Corporation, both suppliers of intermittent catheters, who
began work on changing the policy in 2005. In March 2007, Hollister put
together requirements for reconsideration of the existing policy and
approached CMS with them. In June 2007, CMS indicated that they would
not make the change, citing the long-existing policy's effectiveness.

Undeterred by CMS' firm stance, Hollister and Coloplast continued their
efforts for sterile intermittent catheter change and solicited letters
from organizations such as the Spina Bifida Association, the University
of Miami School of Medicine, the Infectious Diseases Society of America
(IDSA), and the National Multiple Sclerosis Society. These groups
wholeheartedly joined the call for change as they all had grown weary
of complaints from individuals regarding the substandard "re-use policy."

"We worked diligently to get Medicare to reconsider their existing
policy which had been in effect for decades to accurately reflect the
true meaning of "single-use devices" as those that should not be
re-used in any setting," said Russell Miller, Director of Reimbursement
Strategy and Services for Coloplast Corporation.

In November 2007, the Veterans Administration (VA) also developed a
similar argument based on the Food and Drug Administration's (FDA)
policy that urinary catheters are considered single-use devices. The VA
cited that manufacturers of catheters specifically identified them as
single-use. They continued to argue that until manufacturers
specifically changed labeling for urinary catheters, there was no
policy interpretation that would allow the re-use of urinary catheters. This
substantiated their claim that patients should be provided with an
adequate number of sterile catheters to use with each catheterization.

"The VA's argument helped our cause in bringing about change, and the
new Medicare policy that went into effect in April is in compliance
with all individuals' needs," said Deanna Eaves, Senior Reimbursement
Manager at Hollister Incorporated. 

Ultimately, the new policy better supports an individual's desire to
void their bladder with a new catheter on a more consistent basis than
once a week. Both companies and the supporting organizations are
pleased with this outcome. Hollister and Coloplast continue to work vigilantly
on intermittent catheterization policies across the U.S. for patients
needing such quality care.

For more information on the reimbursement policy change log on to
www.medicarenhic.com <http://www.medicarenhic.com/> .