Summary of the ‘Medicare DMEPOS Competitive Acquisition Program Reform Act’
WASHINGTON–While a bill introduced Thursday in the House of
Representatives calls for a moratorium on the implementation of the
competitive bidding program, it would also make improvements to the
bidding process and establish quality measures along with other
improvements, according to Cara Bachenheimer, senior vice president
of government relations for Invacare, Elyria, Ohio.
The bottom line, she said, is an 18- to 24-month delay of round
one, and round two could not occur before January 2011.
The “pay for” would be a 9.5 percent reduction in
2009 for items that CMS included in round one. A CPI update would
then resume in 2010 for these same items as well as all other
DMEPOS items. Items not included in round one (e.g., manual
wheelchairs) would not be cut in 2009 and would receive a full
update in 2009.
Bachenheimer offered the following bullet-point summary of H.R.
6252, the Medicare DMEPOS Competitive Acquisition Program Reform
Act of 2008:
Delay of rounds one and two of the bidding
program:
- Terminate contracts under round one and rebid so that new
contracts would take effect in 18 to 24 months. - Round two contracts cannot take effect before January
2011. - Payment adjustments in non-bid areas may not take effect until
round two is completed.
Offset to pay for the delay:
- In 2009, eliminate the annual payment update (CPI) and reduce
payments by 9.5 percent nationwide for those items subject to
competitive bidding in round one. All other items would receive the
CPI update. - In 2010 through 2013, all items would receive CPI update.
- In 2014, items that had been subject to the 9.5 percent
reduction would receive an additional 2 percent update over the CPI
except in areas where competitive bidding contracts are already in
place.
Bidding process improvements:
- Require CMS to notify bidders of paperwork discrepancies and
give opportunity to correct within a reasonable time frame. - Provide CMS with the authority to subdivide MSAs with 8 million
or more in population. - Exempt rural areas and MSAs with a population of 250,000 or
less from competitive bidding for at least five years. - Require that suppliers who bid on diabetic testing supplies
offer brands that cover at least 50 percent of the market by volume
(does not apply to round one). - Before using its authority to adjust prices in non-bid areas,
CMS must issue a regulation and consider how prices set through
competitive bidding compare to costs for such items in non-bid
areas. - Require HHS’ Office of Inspector General to verify
calculations used to determine the pivotal bid amount and winning
bid amounts.
Quality measures:
- Require all suppliers to be accredited by Oct. 1, 2009. Ensure
that all suppliers, whether billing Medicare directly or
subcontracting, are accredited. - Require contracting suppliers to disclose all subcontracting
relationships to CMS. - Exclude physicians and other practitioners from DME
accreditation. - Establish a separate ombudsman within CMS to handle supplier
and beneficiary issues related to the competitive bidding
program.
Other improvements:
- Exclude complex rehab (group 3 power wheelchairs and above and
the accessories furnished with them) from the bidding program. - Exclude NPWT from round one and require CMS to evaluate how
these items are coded and paid. - Allow physicians and other treating practitioners to supply
off-the-shelf orthotics to their patients without being awarded a
contract. - Allow hospitals in bidding areas to supply the same DME items
that physicians and other practitioners are allowed to supply
(those that are considered an integral part of professional
services, i.e. walkers, canes, crutches, etc.) without being
awarded a contract. - Ensure that podiatrists and other similar practitioners can
prescribe DMEPOS items by using a broader definition of
“physician.” (This was a drafting error in MMA that is
being corrected). - Delay mandated GAO report to coincide with round one and expand
scope of report.
Related Articles
OUR DIGITAL PARTNERS