The National Association for the Advancement of Orthotics and Prosthetics (NAAOP) released its latest webcast in which general counsel Peter Thomas, JD, gives an update on a proposed rule change by the Centers for Medicare & Medicaid Services (CMS) to the durable medical equipment, prosthetics, orthotics, and supplies (DMEPOS) regulations.
CMS will be accepting comments until September 27 on a proposed DMEPOS rule that will change how CMS sets reimbursement levels for new technologies and dramatically expands prior authorization of prosthetics and orthotics. The Medicare Payment Advisory Commission (MedPAC), an independent legislative branch agency that provides Congress with analysis and policy advice on the Medicare program, held a meeting on September 5 that included a session called Examining Competitive Bidding for Diabetes Testing Supplies and Expanding Medicare’s DMEPOS Competitive Bidding Program.
The presentation provided an overview of the competitive bidding program (CBP) implemented under the Medicare DMEPOS payment system, with a particular focus on the impact that CBP has had on spending and utilization for diabetes testing supplies, Thomas said. The presentation set the stage for a discussion of ways to expand the DMEPOS CBP throughout the Medicare program.
MedPAC staff provided an overview of the two payment systems for DMEPOS items, the competitive bidding program and the fee schedule. Staff contended that many DMEPOS fee schedule amounts are “excessive,” and that the implementation of competitive bidding has resulted in “substantially” lower payment rates among the 25 highest-expenditure products in 2017. Median payment rates declined nearly 50 percent.
Though MedPAC admits that utilization decreased for most product categories included in CBP, the commission contends that CBP did not disrupt patient access, citing CMS data that shows no negative changes in beneficiary outcomes, Thomas said. To further support the competitive bidding program, staff cited data demonstrating increased spending on non-CBP products, he said. The presentation also discussed the April Department of Justice enforcement action alleging a nationwide fraud scheme for off-the-shelf orthotics and posited that excessive fee schedule rates for these items likely encouraged the alleged abuse.
Staff concluded the presentation by suggesting that the commissioners and policymakers consider expanding CMS’ authority to include additional products in the CBP, specifically pointing to a list of candidate products identified by MedPAC in 2017.