BALTIMORE--CMS posted the following statement about the delay of competitive bidding on Wednesday:
The Medicare Improvements for Patients and Providers Act of 2008 was enacted on July 15, 2008. This new law has delayed the Medicare Durable Medical Equipment, Prosthetics, Orthotics, and Supplies (DMEPOS) Competitive Bidding Program. Items that had been included in the first round of the DMEPOS Competitive Bidding Program can be furnished by any enrolled DMEPOS supplier in accordance with existing Medicare rules. Payment for these items will be made under the fee schedule. Additional guidance regarding this new law will be forthcoming.
How exactly does the agency plan to handle all that is involved? Here is what we know so far:
--In a July 16 fact sheet, CMS said Medicare beneficiaries may now use any Medicare supplier for DME. If a beneficiary changed suppliers when competitive bidding started, they can either continue to use the new supplier or choose another supplier. The original DME payment rates in effect prior to July 1 are reinstated retroactively.
--The agency said all Medicare households in the 10 round one CBAs will be notified of the delay directly in a letter from CMS by the end of this month. A posting on www.medicare.gov tells visitors that Congress has acted to delay the competitive bidding program and directs beneficiaries to a listing of local suppliers. “Medicare is continuing to make sure you can get the supplies and services you need,” the posting says. “We will post more information about the new program in the future ...We are sorry for any inconvenience this has caused.”
--All information on competitive bidding has been removed from both the CMS competitive bidding Web site (www.cms.hhs.gov/DMEPOSCompetitiveBid) and the CBIC Web site (www.dmecompetitivebid.com). CMS told providers to be aware that any published MLN Matters articles affected by the new law “will be revised or rescinded as appropriate.”
--Accreditation deadlines associated with round two of competitive bidding have been cancelled, although the accreditation deadline for all Medicare DMEPOS suppliers--Sept. 30, 2009--remains in effect. (For more, see “2009 Accreditation Deadline Stands” in this issue.)
--As a result of the new law, the mid-year 2008 Medicare physician fee schedule rate reduction of 10.6 percent is retroactively replaced with the fee schedule rates in effect from January through June, 2008.
--The law also reinstated the therapy caps exceptions process as of July 1. Therefore, medically necessary therapy services, in excess of the therapy caps, will continue to be paid by Medicare in accordance with the exceptions process. Claims submitted with the therapy cap exception modifier will be processed as soon as the payment rates have been activated. Claims submitted without the modifier, and rejected or denied, can be resubmitted with the modifier for reimbursement. More information on therapy caps is available at www.cms.hhs.gov/TherapyServices.
--In addition to the facts coming from CMS, the American Association for Homecare has been in talks with CMS about the implications of the new law as it applies to DMEPOS. Representatives from the group met with CMS officials last week to “begin work on clarifying issues related to the delay in the competitive bidding program,” and CMS has agreed to produce a “Frequently Asked Questions” document for provider use.
--A Friday afternoon update from AAHomecare said CMS had held its first educational conference call earlier in the day on how the agency will implement the delay. According to the update, CMS’ carriers will reprocess any claims impacted by competitive bidding between the dates of July 1 and July 15, 2008.
--The association also said CMS will look into issues related to the repeal of the oxygen equipment transfer to beneficiaries enacted in the new law, including issues of maintenance and service payments that occur once the 36-month rental cap is reached, and “respond soon.” --AAHomecare said CMS plans to hold a provider call to answer questions related to the ending of round one “in the near future.”
For now, AAHomecare pointed out the following important facts for providers to note:
- The cost of the competitive bidding delay will be offset by a nationwide 9.5 percent reduction in current payment rates for round one DME items, effective Jan. 1, 2009.
- The law repeals transfer of ownership of oxygen equipment that was enacted in the Deficit Reduction Act of 2005. After the 36th continuous month during which payment is made for oxygen equipment, the supplier will continue to maintain ownership of the equipment. Payments for oxygen contents will be made after the 36th month. However, rental payments for oxygen equipment are still subject to the 36-month cap. Maintenance and servicing payments after 36 months are still under development by CMS.
- The law terminates contracts under round one and will restart the contracting process in 2009, delaying program implementation for 18 months. The round two contracting process begins in 2011. Payment adjustments in non-bid areas may not take effect until round two is completed.
- In 2010 through 2013, all items would receive a Consumer Price Index (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.