July 2, 2009

NEW ROUND OF COMPETITIVE BIDDINGFOR DURABLE MEDICAL EQUIPMENT, PROSTHETICS, ORTHOTICS, AND SUPPLIES

On June 18, 2009, and again on June 26, the Centers for Medicare & Medicaid Services (CMS) announced plans to begin accepting a new round of competitive bids from suppliers of durable medical equipment, prosthetics, orthotics, and supplies (DMEPOS).  Later in the Summer of 2009, CMS will announce its DMEPOS bidding schedule, including a schedule of educational events for prospective bidders, along with the timing of its bidder registration period.  Moreover, the current announcements encourage prospective bidders to complete their mandatory DMEPOS accreditation requirements by September 30, 2009.  In the Fall of 2009, CMS will launch the actual bidding competition.  

Of importance to advocates and beneficiaries is the need to remain alert to upcoming changes.  The DMEPOS competitive bidding process will result in a different array of suppliers who are eligible to provide Medicare-covered DMEPOS.  For some beneficiaries, this may necessitate a change of suppliers; for others, no changes will be necessary.  Advocates can visit the DMEPOS competitive bidding program section of the CMS website for the latest developments: www.cms.gov/DMEPOSCompetitiveBid/.

Background

·         See the Center for Medicare Advocacy’s Weekly Alert for February 26, 2009: http://www.medicareadvocacy.org/PartB_09_02.26.CompetitiveBiddingDelayed.htm.

·         The DMEPOS competitive bidding process was delayed until April 18, 2009.[1] 

·         The DMEPOS program is a requirement of Section 302 of the Medicare Prescription Drug, Improvement, and Modernization Act of 2003 (MMA).[2]

·         The DMEPOS Competitive Bidding Implementation Contractor (CBIC) is Palmetto GBA: www.dmecompetitivebid.com.

Competitive Bidding Areas

DMEPOS Competitive bidding is to occur in the nine largest Metropolitan Statistical Areas (MSAs):   Cincinnati – Middletown (OH, KY and IN); Cleveland –Elyria-Mentor (OH); Charlotte-Gastonia-Concord (NC and SC); Dallas-Fort Worth-Arlington (TX); Kansas City (MO and KS); Miami- Fort Lauderdale-Miami Beach (FL); Orland (FL); Pittsburgh (PA); Riverside-San Bernardino-Ontario (CA).

Categories of Items and Services for Rebid

The Round 1 rebid will include the following categories of items and services:
 

• Oxygen Supplies and Equipment;

• Standard Power Wheelchairs, Scooters, and Related Accessories;

• Complex Rehabilitative Power Wheelchairs and Related Accessories (Group 2); 

• Mail-Order Diabetic Supplies;

• Enteral Nutrient, Equipment and Supplies;

• Continuous Positive Airway Pressure (CPAP);

• Respiratory Assist Devices (RADs), and Related Supplies and Accessories;

• Hospital Beds and Related Accessories;

• Walkers and Related Accessories;

• Support Surfaces (Group 2 mattresses) and overlays in Miami.

The MMA requires that the competitive bidding program be phased in first for those items which have the greatest potential for savings.  This includes high cost and high volume items.  The items will be chosen based on: total Medical expenditures (allowable charges) for the item; growth in Medicare expenditures; number of suppliers of the item; savings potential; and findings, reports and studies by the Office of Inspector General (OIG) or the Government Accountability Office (GAO).

Certain Providers Exempted

The competitive bidding process also allows for the grandfathering of certain special physician/practitioners - nurses, physician assistants, clinical nurse specialists, and physical therapists and occupational therapists in private practice - to receive payment for certain competitively bid items furnished to their own patients as part of the professional service even though they have not submitted a bid and have not been selected as a contract supplier. 

Beneficiaries who are renting an item of DME, or oxygen and oxygen equipment, that meets the definition of a grandfathered item may elect to obtain the item from a grandfathered supplier. The rules also contain special provisions for small suppliers, including forming networks of small suppliers.

Conclusion

As the DMEPOS competitive bidding process begins in earnest through the summer and fall of 2009, advocates and beneficiaries should be certain to talk to their suppliers of DMEPOS.  It will be necessary to know whether they are preparing to bid, and whether they are accredited as required under the DMEPOS program. 

For more information, contact attorney Alfred Chiplin in the Center for Medicare Advocacy's Washington, DC office at (202) 293-5760 or achiplin @ medicareadvocacy.org (remove spaces).

Copyright © 2010 Center for Medicare Advocacy, Inc.