Washington Wit & Wisdom

Don't Be Surprised

CMS is proposing a raft of changes for 2011.
by Cara C. Bachenheimer

The Centers for Medicare and Medicaid Services posted its 2011 Proposed Medicare Physician Payment Rule (Medicare Program; Payment Policies under the Physician Fee Schedule and Other Revisions to Part B for CY 2011) online June 25. This proposed rule contains a number of provisions related to DME and oxygen. (Note that this is a proposed rule. Public comments were due by Aug. 24, and a final rule will be issued this fall. If finalized, the changes will be effective Jan. 1, 2011.)

Following are the key areas of interest related to the home medical equipment industry.

21 Additional Bid Areas

Implementing Congress' mandate in the Patient Protection and Affordable Care Act (PPACA) to expand Round 2 of the DME competitive bid program, CMS is proposing the following 21 areas be added to the 70 areas it announced in January 2008. Round 2 is scheduled to be implemented in January 2013, with bidding to begin in the spring of 2011.

  • Philadelphia-Camden-Wilmington, PA-NJ-DE-MD
  • Washington-Arlington-Alexandria, DC-VA-MD-WV
  • Boston-Cambridge-Quincy, MA-NH
  • Phoenix-Mesa-Scottsdale, AZ
  • Seattle-Tacoma-Bellevue, WA
  • St. Louis, MO-IL
  • Baltimore-Towson, MD
  • Portland-Vancouver-Beaverton, OR-WA
  • Providence-New Bedford-Fall River, RI-MA
  • Buffalo-Niagara Falls, NY
  • Rochester, NY
  • Tucson, AZ
  • Honolulu, HI
  • Albany-Schenectady-Troy, NY
  • Worcester, MA
  • Oxnard-Thousand Oaks-Ventura, CA
  • Springfield, MA
  • Bradenton-Sarasota-Venice, FL
  • Poughkeepsie-Newburgh-Middletown, NY
  • Stockton, CA
  • Boise City-Nampa, ID

Subdivision of Large MSAs

CMS wants to subdivide New York, Chicago and Los Angeles into smaller bid areas. The New York MSA would be divided into five separate bid areas, Chicago into four bid areas and Los Angeles MSA into two bid areas.

National Competitive Bid Program for Mail-Order Diabetic Supplies

CMS is proposing to establish a national mail-order competitive bid program that would take place after 2010 to award contracts to furnish replacement diabetic testing supplies across the nation. The agency notes that its decision to proceed with a national mail-order competition after 2010 does not prevent CMS from phasing in competitions for non-mail order diabetic supplies or from conducting competitions for diabetic supplies in general in the future.

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