Timothy Caruso-IL

Mr. Kerry N. Weems Acting Administrator Centers for Medicare and Medicaid Services U.S. Department of Health and Human Services Attention: CMS-6036-P P.O. Box 8018 Baltimore, MD 21244-8018. Subject:Medicare Program; Establishing Additional Medicare Durable Medical Equipment, Prosthetic, Orthotic, and Supplies (DMEPOS) Supplier Enrollment Safeguards: Proposed Rule. DMEPOS Supplier Standards. I am a Physical Therapist praciticing for over twenty years with patients receiving medicare and medicaid services. I would like to comment on the January 25, 2008 proposed rule on additional standards for DMEPOS suppliers. As a Physical Therapist I may provide orthotics and other DME items to my patients as an integral part of my plan of care however it is only a small part of what I do with patients in their treatment which differs from the work of commercial suppliers who sell DMEPOS as thier primary line of work. I urge CMS to revise the proposed regulations to exempt physical therapists from the requirements related to space sharing, posting of office hours, and the $300,000 liability insurance per incident. Physical Therapists who provide DMEPOS items as an integral part of patient care to Medicare patients are licensed by the state in which they practice and subject to a wide range of regulatory and other requirements. In light of these requirements, having to meet the same standards as a supplier company, that is not a licensed health care professional is unnecessary and overly burdensome. For physical therapists, Medicare-covered DMEPOS products make up a small proportion of the services that we furnish. Thus it is not feasible to incur the substantial costs to meet the requirements proposed in this rule. Applying these standards to a physical therapist private practice does not make good financial sense. For example, the proposal to prohibit a DMEPOS supplier from sharing a practice location with another Medicare supplier, "including a physician/physician group or another DMEPOS supplier," could preclude a physical therapist from providing both orthotics and other services to his/her patients in the same practice location. These requirements will pose a serious threat to timely patient access to medically necessary DMEPOS. There are regular situations in which patients require an item to be available to them during their visit to assist with mobility or to stabilize an injured body part which this change would severely limit. Thank you for your consideration in this matter. Sincerely, Timothy Caruso PT