ATLANTA, Georgia (Nov. 5, 2020)—The Centers for Medicare & Medicaid (CMS) is seeking an unprecedented level of advice from stakeholders even as it makes major changes to the competitive bidding program, Mark Higley, vice president or regulatory affairs for VGM, and others said Wednesday. 

CMS announced Oct. 27 that only two of the 15 categories in the latest round of competitive bidding for durable medical equipment, prosthetics and orthotics (DMEPOS), off-the-shelf back and knee braces, would move forward. In the proposed rule, it also asked repeatedly for additional input from the industry. 

“For someone that has read proposed rules for 18 years, the amount of frequency of CMS’s writers that said we are looking for comments, we are looking for stakeholder input—it was almost in every paragraph—I’ve never seen that before,” Higley said. “I think the agency at this time is more open to input than ever before.” 

Higley was joined at the opening session of Medtrade Virtual by two other VGM experts—Ronda Buhrmester, senior director of payer relations and reimbursement, and Craig Douglas, vice president of payer and member relations—to review the latest on the competitive bidding program, including diving deep into the proposed rule issued Oct. 27. The event, which was scheduled to be held live in Atlanta, was conducted online Nov. 4 and 5.

All three encouraged home medical equipment (HME) providers to submit their comments, which are due before January 3, 2021, and to be specific, including referencing any features from the proposed rule or the three alternatives CMS considered that would be beneficial or detrimental to their business. 

“You can say, here’s what I like, here’s what’s missing, here’s what I don’t like,” Higley said. “Pick and choose the features from each one that you think are pertinent and relevant to your business and the industry as a whole.” 

In general, the state of the industry is strong, Higley said. 

“While we’ve weathered a number of issues, from the audits, from the competitive bidding program, the industry remains strong,” he said. “The demand is incredible … Our glass is more than half full. The epidemic is a glitch.” 

Some things to note: 

  • There is a wide and unexpected amount of variation in prices for the off-the-shelf back and knee branches—by as much as $800 in some cases. While there have been price differences in prior bidding rounds, especially on oxygen and CPAP items, it has never been this dramatic. “This is something that this team here has never seen,” Higley said. 
  • Buhrmester said that providers who receive a notice of disqualification that says documents they loaded into the system are missing, such as accreditation or liability insurance, have 30 days from receiving the notice to appeal. No appeals are allowed based on bid price, and appeals must be made through the portal. 
  • Those offered a contract must respond by Nov. 10.