In a recent news release, the Centers for Medicare & Medicaid Services (CMS) announced that it will be seeking public input as it progresses toward the nationwide implementation of the Medicare Durable Medical Equipment, Prosthetics, Orthotics, and Supplies (DMEPOS) Competitive Bidding Program.
The deadline to submit comments is March 28.
CMS notes in the release that currently, competitive bidding is in effect for a national mail order program for diabetic testing supplies and for additional items in 100 areas across the nation. It adds that by 2016, Medicare must implement competitive bidding or competitive bidding pricing for included items to non-competitive bidding areas.
CMS is calling for public comment regarding the methodology it would use to comply with the statute when using competitive bidding pricing information to adjust payment amounts in non-competitive bidding areas. Additionally, the release states that CMS is requesting comments centered on ideas for potentially simplifying the payment rules and improving beneficiary access to items and services under the competitive bidding programs for certain durable medical equipment (DME) and enteral nutrition.
The release reports that Medicare conventionally pays for DMEPOS items using a fee schedule that is generally based on what suppliers are charged for the items and services during the 1980s and increased by annual update factors. A range of studies, CMS says, from the Department of Health and Human Services Office of Inspector General and the Government Accountability Office suggest these fee schedule prices are excessive, and that taxpayers and Medicare beneficiaries hold the burden of these excessive payments.
According to the release, under the program, DMEPOS suppliers compete to become Medicare contract suppliers, submitting bids to provide certain items in competitive bidding areas. The new, lower payment amounts yielding from the competition replace the fee schedule amounts for the bid items in these areas.
CMS states that the Affordable Care Act amended the statue to mandate use of information from the DMEPOS competitive bidding program to adjust the fee schedule amounts for DME in areas where competitive bidding programs are not implemented by no later than January 1, 2016. As a result of adjusting the fee schedule based upon the Competitive Bidding program, CMS has called for comments regarding the several aspects that it would consider in developing methodology to adjust DMEPOS fee schedule amounts or other payment amounts in non-competitive areas behind DMEPOS competitive billing information.
Areas that CMS is seeking input in include whether the costs of providing a range of DMEPOS items and services vary based on the geographic area in which they are provided, and whether the costs of providing a range of DMEPOS items and services differ based upon the size of the market served in terms of population and/or distance covered or other logistical or demographic reason. Additionally CMS is looking to gather feedback on whether an interim or different methodology should be used to adjust payment amounts for items that have not yet been included in all competitive bidding programs, such as TENS devices.
CMS says it is also considering whether different payment rules for DME and enteral nutrients, supplies, and equipment should be considered under the competitive bidding programs. It is now asking for comments regarding whether it should consider simplifying the payment rules under competitive bidding programs for certain DME and enteral nutrition by making one monthly payment to the supplier or all related items and services needed each month. The monthly payments, the release notes, would continue as long as medical necessity for the covered items continued and the supplier would be responsible for providing all items and services each month.
To this end, CMS says it is looking for input in several areas that include whether lump sum purchases and capped rental payment rules for DME and enteral nutrition equipment are still needed, whether there are reasons as to why beneficiaries need to own expensive DME or enteral nutrition equipment, and whether there might be any negative impacts linked to continuous bundled monthly payments for enteral nutrients, supplies, and equipment or for certain DME.
Read the release in full here
Review the ANPRM here