Competitive Bidding
Durable Medical Equipment, Prosthetics, Orthotics and Supplies (DMEPOS)
HIDA supports modifications to the competitive bidding program for durable medical equipment, prosthetics, orthotics, and supplies (DMEPOS) that promote efficient, cost-effective solutions while maintaining quality, access, and choice for patients.
The competitive bidding program fundamentally changed Medicare’s approach to reimbursing DMEPOS suppliers under Medicare Part B. Prior to the program, Medicare paid for these items using a fee schedule generally based on historic supplier changes. Officials believed these fees were excessive and began implementing the new system in 2011 to establish a single Medicare payment for each item through a bidding process between CMS and designated suppliers. The program was originally rolled out in a limited number of metropolitan statistical areas (MSAs) and then expanded in “rounds.”
What Members Need to Know
The competitive bidding program has had a significant impact on HIDA member suppliers of nursing home, home care and extended care products as well as the providers they serve. To date, there has been little independent analysis to evaluate how significantly the program has restricted the types of products available for patients or compromised physician decisions to prescribe specific products that are determined to be most appropriate for the patient’s medical and physical condition.
HIDA’s concern, and that of other organizations, is that restricting access to products determined to be essential for their unique medical conditions could lead to major adverse health events for patients and increased utilization and spending for Medicare. In particular, HIDA has raised concerns about how quickly the Centers for Medicare and Medicaid Services (CMS) is phasing in prices for DMEPOS established in competitively bid areas to those areas that have not been subject to competitive bidding, mostly in rural areas with a higher “cost to serve.”
Product areas covered under the DMEPOS competitive bidding program include:
- Enteral Nutrients, Equipment, and Supplies
- General Home Equipment and Related Supplies and Accessories
- Nebulizers and Related Supplies
- Negative Pressure Wound Therapy Pumps and Related Supplies and Accessories
- Respiratory Equipment and Related Supplies and Accessories
- Standard Mobility Equipment and Related Accessories
- Transcutaneous Electrical Nerve Stimulations Devices and Supplies
Outlook
Current competitive bidding contracts expired on December 31, 2018. CMS published a final rule which redesigns the competitive bidding program based on lead item pricing. While CMS continues to work with industry partners on the design of the new program, they have issued a temporary gap period as of January 1, 2019. During this time beneficiaries may receive DMEPOS items from any willing supplier until new contracts are awarded. The temporary gap period is expected to last at least through 2020. HIDA Government Affairs continues to stay engaged with CMS in order to provide industry input.
CMS advises providers to continue to monitor these websites – www.cms.gov and www.dmecompetitivebid.com – for updates.