BALTIMORE — In a late Friday list-serv message, CMS announced that the following final rule is on display at the Federal Register: "Medicare Program; Payment Policies Under the Physician Fee Schedule and Other Revisions to Part B for CY 2010."
The new final rule includes rules on:
- maintenance and servicing of oxygen equipment;
- the establishment of a notification process for suppliers choosing to become grandfathered suppliers under the DMEPOS competitive bidding program; and
- payment for damages resulting from termination of contracts awarded in 2008 under Round 1.
The text of the message follows:
Maintenance and Servicing of Oxygen Equipment
New rules regarding payment and supplier responsibilities for maintenance and servicing of oxygen equipment have been established in accordance with Medicare Improvements for Patients and Providers Act (MIPPA) of 2008 requirements. The new maintenance and servicing rules permit payment every 6 months, beginning 6 months after the end of the 36-month rental payment cap, for maintenance and servicing of oxygen concentrators and transfilling equipment to ensure that the equipment is kept in good working order for the safety of the beneficiary. The new rules are effective for items furnished on or after July 1, 2010. The maintenance and servicing policy established for 2009 as part of an Interim Final Rule (73 FR 69726) will continue for items furnished through June 30, 2010.
Beginning July 1, 2010, a single maintenance and servicing payment of $66 may be made once every 6 months for maintenance and servicing of an oxygen concentrator (stationary or portable) and, if applicable, oxygen transfilling equipment. Separate payment is not made for each piece of equipment serviced. The maintenance and servicing payment does not apply to liquid or gaseous oxygen equipment (stationary or portable). The maintenance and servicing fee covers all maintenance and servicing needed during the 6-month period. The supplier is responsible for performing all necessary maintenance, servicing and repair of the equipment at the time it is needed and must also visit the beneficiary's home during the first month of each 6-month period to inspect the equipment and perform any necessary maintenance and servicing needed at the time of each visit.
CMS will issue program guidance with specific information for claims processing and beneficiary education over the next few months.
Grandfathering Notification Process
A process has been established for suppliers that are not awarded contracts under the DMEPOS Competitive Bidding Program to provide notification of their decisions regarding whether they will continue furnishing rented durable medical equipment (DME) and/or oxygen and oxygen equipment as grandfathered suppliers under the program. This process requires noncontract suppliers to provide written notification of their grandfathering decisions to CMS and all Medicare beneficiaries who reside in a competitive bidding area to whom they are furnishing these items. The process also requires beneficiaries to notify grandfathered suppliers regarding whether they wish to continue receiving their items from a grandfathered supplier.
The regulation also establishes a requirement that there be coordination between contract and noncontract suppliers regarding the removal and delivery of medically necessary items to and from a beneficiary's home. Noncontract and contract suppliers are required to work together to ensure that DMEPOS services are uninterrupted. A grandfathered item is defined in the regulation to encompass all oxygen and oxygen equipment or all rented DME within a product category other than oxygen and oxygen equipment. Therefore, if a supplier chooses to become a grandfathered supplier for oxygen and oxygen equipment, it must continue to furnish all items of oxygen and oxygen equipment to all beneficiaries who choose to continue receiving the items from the grandfathered supplier. Likewise, if a supplier chooses to become a grandfathered supplier for an item of rented DME in a given product category, it must continue to furnish all rented DME in the product category to all beneficiaries who choose to continue receiving the items from the grandfathered supplier.
Process for Considering Claims for Damages
MIPPA terminated contracts awarded under Round 1 of the Medicare DMEPOS Competitive Bidding Program and stipulated that, to the extent that any damages may be applicable as a result of the termination of contracts, such damages shall be payable from the Federal Supplementary Medical Insurance Trust Fund.
In accordance with the final regulation, claims for damages may only be filed by suppliers that submitted a bid and were awarded a contract in 2008 during Round 1 of the program. Any damages that are claimed must be substantiated and must be the direct result of termination of a contract under Round 1 of the program. The extent of the obligation for payment of damages is limited to damages realized by the contract supplier. Therefore, entities that entered into subcontracting relationships with a contract supplier for purposes related to furnishing items and services under the program are not eligible to submit claims for damages.
The Competitive Bidding Implementation Contractor (CBIC) will be the intake point for claims for damages, which will be reviewed by the CBIC and CMS. Claims must comply with all requirements specified in the final regulations. The CBIC will accept claims that are submitted by April 1, 2010. The date of submission is the actual date of receipt of the completed claim by the CBIC. No claims for damages will be accepted if they are received by the CBIC after April 1, 2010. If a claim for damages is not submitted by the deadline, the CBIC will recommend to CMS not to process the claim any further.
Claims for damages must be submitted in writing to the following address (electronic submissions via e-mail or facsimile will not be accepted):
Competitive Bidding Implementation Contractor
2743 Perimeter Pkwy., Ste. 200-400
Augusta, Georgia 30909-6499
Every effort will be made to make a determination within 120 days of initial receipt of a claim or the receipt of additional information, whichever is later. However, in the case of more complex cases, or in the event that a large volume of claims is submitted, it may take more than 120 days to process a claim.
The final rule can be viewed at federalregister.gov/page2.aspx.
