CMS Says Legacy DME Categories Won’t Be in New Bidding Round

WASHINGTON—A wide range of durable medical equipment (DME), including oxygen, mobility and CPAP products, will not be included in the upcoming round of the competitive bidding program, according to an update from the Centers for Medicare & Medicaid Services (CMS). 

CMS updated its fact sheet on the Durable Medical Equipment, Prosthetics, Orthotics, and Supplies (DMEPOS) Competitive Bidding Program (CBP), as outlined by a recently issued final rule. In the update it clarified that legacy products from previous rounds of competitive biddingwill not be included in the bidding round scheduled to begin next year. 

According to the American Association for Homecare, the updated fact sheet changes the heading above the product categories listed from the previous Remote Item Delivery (RID) DMEPOS CBP Product Categories to the new DMEPOS CBP Product Categories and adds a note that “All product categories for the next round will be included in the Nationwide Remote Item Delivery Program.”

Major points highlighted in the updates include: 

• All the bidding-related information technology systems have been consolidated into one system, Connexion, CMS’ DMEPOS CBP secure portal.
• Single payment amounts are now calculated using the 75th percentile of winning bids instead of the maximum winning bid.
• Contract suppliers for each product category will be responsible for furnishing all items under the product category to all Medicare beneficiaries regardless of where they live. Only contract suppliers can furnish items included under the nationwide RID CBP that are covered under Medicare Part B.
• The number of contracts offered for each product category will be based on 125% of the number of suppliers furnishing at least 3% of total national allowed services for the lead item in 2025.
• Payment for CGMs and insulin infusion pumps will be made on a continuous, monthly rental basis with payment for all necessary supplies and accessories included in the monthly rental rates beginning on the first day of the contract period.
• Limitations on bid amounts
   

The list of products included in the next round is listed below:

• Class II Continuous Glucose Monitors (CGMs) and Insulin Pumps
• Urological Supplies[1]
• Ostomy Supplies
• Hydrophilic Urinary Catheters
• Off-The-Shelf (OTS) Back Braces
• OTS knee braces
• OTS Upper Extremity Braces
  *All product categories for the next round will be included in the Nationwide Remote Item Delivery Program.

The updates have garnered responses from various homecare advocacy groups including AAHomecare. 

“This is a significant win for a large segment of the home medical equipment community and the patients they serve,” said Tom Ryan, AAHomecare president and CEO. “It’s a great result following the wave of comments and our industry’s comprehensive advocacy effort responding to a flawed framework for restarting the bidding program. Even with this win in hand on many product categories, there is still work to be done. AAHomecare plans to continue efforts to delay the next bidding round or improve its framework on behalf of diabetes, ostomy and urological product stakeholders who will be subject to bidding. I know that companies who provide these products and patient advocates are still committed to that fight—and AAHomecare is going to fight alongside them.”