CMS Issues Competitive Bidding Final Rule…
Today, CMS issued a final rule establishing a competitive bidding program for Durable Medical Equipment, Prosthetics, Orthotics, and Supplies (DMEPOS) furnished to Medicare Beneficiaries under Part B. Competitive bidding will harness marketplace dynamics to provide quality items and services in an efficient manner and at a reduced cost both to the Medicare program and to beneficiaries. The law requires that competition under the program begin in 2007 in 10 of the largest Metropolitan Statistical Areas (MSAs), 80 of the largest MSAs in 2009 and additional areas after 2009. The 10 MSAs for 2007 include: (1) Miami – Fort Lauderdale – Miami Beach, FL; (2) Charlotte – Gastonia – Concord, NC-SC; (3) Dallas – Fort Worth – Arlington, TX; (4) Orlando, FL; (5) Riverside – San Bernardino – Ontario, CA; (6) Pittsburgh, PA; (7) Kansas City, MO-KS; (8) Cincinnati – Middletown, OH-KY-IN; (9) San Juan – Caguas – Guaynabo, PR; and (10) Cleveland – Elyria – Mentor, OH.
And the Initial Ten Categories of DMEPOS are…
Ten categories of DMEPOS
were chosen to be competitively bid for a variety of factors, including high
price and high utilization. The first round of competition under the new
program will be conducted on (1) Oxygen Supplies and equipment; (2) Standard
Power Wheelchairs, Scooters, and Related Accessories; (3) Complex
Rehabilitative Power Wheelchairs and Related Accessories; (4) Mail-Order
Diabetic Supplies; (5) Enteral Nutrients, Equipment, and Supplies; (6)
Continuous Positive Airway Pressure (CPAP) Devices, Respiratory Assist
Devices (RADs), and Related Supplies and Accessories; (7) Hospital Beds and
Related Accessories; (8) Negative Pressure Wound Therapy (NPWT) Pumps and
Related Supplies and Accessories; (9) Walkers and Related Accessories; and
(10) Support Surfaces (Group 2 and 3 mattresses and overlays) – MIAMI & SAN
JUAN ONLY.
Diabetic Supplies… what does this mean for retail pharmacies?
Under the competitive bidding program, beneficiaries will continue to have the option of obtaining diabetic supplies through mail-order or other modes of delivery. However, only mail-order diabetic supplies are subject to competitive bidding at this time. If the beneficiary chooses to obtain their diabetic supplies from a local pharmacy or supplier storefront or by supplier delivery other than mail delivery, then they can obtain the supplies from any enrolled Medicare supplier and payment for the supplies will be based on the current fee schedule payment methodology.
In no case will a beneficiary’s choice of their blood glucose monitor be affected by the competitive bidding program. The blood glucose monitors are not subject to competitive bidding at this time.
Small Supplier protections added…
A number of protections have been included to ensure small supplier participation and access to the competitive bidding market, including establishing a target number for small suppliers equal to 30 percent of the number of winning suppliers, allowing small suppliers to form networks to participate in the bidding process, and granting small suppliers the flexibility to choose the product categories on which they will submit bids (as suppliers will not be required to submit bids for all product categories). A small supplier is defined as a supplier that generates gross revenue of $3.5 million or less in average annual receipts, including Medicare and non-Medicare revenue.
For more information please see the press release, fact sheets or visit our competitive bidding website.