MIAMI—AMEPA President Rob Brant told members in an email Friday he expects some worrisome questions during CMS’ Sept. 2 teleconference on the Round 1 rebid.
 
The second in a series of eight Special Open Door Forums on the reprised DMEPOS bid program, the presentation will cover product categories and bidding rules. Officials will also give an overview of “special rules” for physicians, skilled nursing facilities and hospitals, a CMS notice said.
 
Brant will be listening, especially when it comes to the portion of the call on enteral nutrition and nursing homes or SNFs.
 
CMS’ Request for Bid instructions note that SNFs aren’t exempt from the bidding program, Brant said. They can, however, choose to become a “specialty supplier” and be awarded a contract to furnish competitively bid items only to their own residents—and thus would be exempt from servicing the entire competitive bidding area.
 
That, Brant said, could be an issue. Here’s how he illustrated the point:
 
Two companies try to provide the government with the lowest price to provide widgets, or in this case, enteral feed supplies and services for the DMEPOS competitive bidding program.
 
Company A has to rent a physical plant, purchase delivery vehicles, maintain delivery technicians, and has to guarantee to cover a multi-county area over 6,000 square miles in size with a variety of brands of feed, educate, train, troubleshoot, service, repair and replace feeding pumps and other delivery products, on-call 24 hours a day for three years.
 
Company B is a nursing home/skilled nursing facility and provides the same products and services in a 20-bed, 6,000-square foot facility. Company B does not have to rent a physical plant or purchase delivery vehicles and most importantly, does not have to guarantee service coverage over a 6,000-square mile, multi-county area, so they only need one delivery technician.
 
It would be simple enough to guess which company could place the lowest bid price, but what complicates the issue is that Company B, in their 6,000-square foot facility, may set the reimbursement rates for all winning bidders trying to cover a 6,000-square mile, multi-county area. That may be exactly what Medicare set up when they released the Request for Bid (RFB) instructions as they pertain to 'Specialty Suppliers.’”

Heavy service requirements and reimbursement issues complicate the enteral products bidding category further, Brant said.
 
“There are over a hundred different brands that a physician may order for a patient. Depending on how the patient reacts to a formula, the physician may change the brand of feed from one day to the next,” he said.
 
Most enteral products are paid using only two different billing codes, so a product that is typically ordered for renal failure patients might cost four times as much as others, but the reimbursement rates are the same, he explained. “These calculated losses cause non-participating providers to refuse accepting Medicare assignment for those enteral patients, an option that bid winners will not have,” he said.

Brant pointed out the enteral nutrition category had been dropped from the second round of the Polk County, Fla., bidding demonstration in 2001.  
 
In 2007, providers again raised red flags about patient care and access following CMS’ decision not to include enteral nutrition under the grandfather clause of its final rule on competitive bidding, along with the absence of a transition period for enteral nutrition recipients. (See Enteral Nutrition Sector Raises Concerns about Patient Care under NCB, July 16, 2007.)
  
“This new chapter in the enteral feed saga will likely lead to questions” during CMS’ upcoming call, Brant said.
 
He’s already asking a couple of his own: “How do ‘special suppliers’ affect the bid price, and should their bids be removed when calculating bid winning rates for a CBA?”
 
To listen in to the CMS call, scheduled from 2 to 3 p.m. ET Wednesday, Sept. 2, dial 800/837-1935 and reference conference ID 23044340.
 
For a list of the remaining Special Open Door calls on the Round 1 rebid, see the CBIC Web site at www.dmecompetitivebid.com.