The National Association for the Advancement of Orthotics & Prosthetics (NAAOP) has issued an update regarding the status of the Centers for Medicare & Medicaid Services (CMS) competitive bidding program and the potential implications for the O&P profession. The update appears below in edited form:
On Wednesday, November 3, the Centers for Medicare & Medicaid Services (CMS) released the list of the 356 suppliers that have contracts with Medicare to provide certain medical equipment and supplies to beneficiaries in nine communities-referred to as Metropolitan Statistical Areas (MSAs)-across the United States at competitively bid rates. The CMS durable medical equipment, prosthetics, orthotics, and supplies (DMEPOS) competitive bidding program aims to save Medicare and its beneficiaries nearly $28 billion over 10 years. CMS achieves these savings through steep cuts in reimbursement rates averaging 32 percent on the durable medical equipment (DME) items selected under the program.
The competitive bidding program goes into effect on January 1, 2011, for beneficiaries in the following areas:
- Charlotte, North Carolina
- Cincinnati, Ohio
- Cleveland, Ohio
- Dallas, Texas
- Kansas City, Missouri and Kansas
- Miami, Florida
- Orlando, Florida
- Pittsburgh, Pennsylvania
- Riverside, California
To decide the competitively bid rate, CMS accepted supplier bids from the nine regions on certain items of durable medical equipment and supplies. The new, lower rates also mean that beneficiaries will pay less than they currently pay in copayments (approximately $10 billion less over ten years).
Although orthotics and prosthetics are essentially exempted from the current competitive bidding program, the fee cuts are indicative of an economic climate under which providers and suppliers in the DME area will undergo tremendous turmoil in the coming years. And this environment could have a spillover effect on O&P care. The extent to which this may occur is not currently known. In addition, CMS may accept bids for “off-the-shelf” orthotics in a future round of bidding; the results of this first round will illustrate what can be expected if and when competitive bidding is applied to off-the-shelf orthotics.
DME impacted by the first round of competitive bidding includes the following:
- Oxygen supplies and equipment.
- Standard power wheelchairs, scooters, and related accessories.
- Complex rehabilitative power wheelchairs and related accessories (group 2).
- Mail-order replacement diabetic supplies.
- Enteral nutrients, equipment, and supplies.
- CPAP, RADs, and related supplies and accessories.
- Hospital beds and related accessories.
- Walkers and related accessories.
- Support surfaces (group 2 mattresses and overlays) in Miami.
Based on bids submitted by these suppliers, beneficiaries and Medicare will see prices, on average, 32 percent lower than Medicare currently pays for the same items. To alleviate potential disruptions in access, CMS plans to launch a comprehensive public education effort to include mailings to beneficiaries, a full range of Internet-based and printed program information, and educational teleconferences. In addition, CMS asserts the 1.800.MEDICARE customer service representatives and caseworkers will be ready to assist beneficiaries. It should be noted that CMS’ announcement of the winning suppliers was issued later than expected, leaving little time for beneficiaries to make arrangements with new suppliers if their existing supplier did not win a contract from CMS and are not grandfathered into the program.
Beneficiaries can expect to receive notices from their current DME suppliers alerting them about whether they will continue to supply devices under the new program. There are also provisions for grandfathering certain providers who are currently providing ongoing DME to beneficiaries. In addition, once the new program is implemented, if beneficiaries are prescribed a device that is not supplied by their new Medicare contractor, that supplier must make a good faith effort to find another competitively bid contractor that can supply that device or work with the prescribing medical professional to find a substitute.
A “Competitive Acquisition Ombudsman” will be available at CMS to respond to complaints and inquiries from suppliers and beneficiaries about the application of the program and issue an annual Report to Congress. A list of Medicare contract suppliers in the nine initial areas is posted at www.medicare.gov (under “Resource Locator” select “Medical Equipment and Supplies”). Beneficiaries can also call 1.800.MEDICARE (TTY users should call 1.877.486.2048) to find a local supplier. Also, local offices of various partner groups, such as State Health Insurance and Assistance Program, Area Office on Aging, can provide information on the program and can help find Medicare contract suppliers.
CMS has set up a website for the Medicare DMEPOS Competitive Bidding Program. You can also visit the Competitive Bidding Implementation Contractor website.
NAAOP will continue to keep its membership informed of developments as they occur. For more information, visit www.naaop.org or e-mail [email protected]