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Please use this link to access information on the Competitive Bidding Program and the devastating effects it will have on Medicare beneficiaries nationwide.  The link will provide you with access to your Legislators.  It also contains preformatted letters that you can send to them or you can use as a guide to write your own.  https://www.facebook.com/peopleforqualitycare/posts/1293858977309042

FACT SHEET

FOR IMMEDIATE RELEASE                                   Contact: CMS Media Relations
July 2, 2014                                                                (202) 690-6145 or press@cms.hhs.gov

CMS PROPOSALS TO UPDATE POLICIES AND PAYMENT RATES FOR END-STAGE RENAL DISEASE PROVIDERS FOR CY 2015 AND PROPOSALS FOR IMPLEMENTATION OF COMPETITIVE BIDDING-BASED PRICES FOR DURABLE MEDICAL EQUIPMENT, PROSTHETICS, ORTHOTICS, AND SUPPLIES

OVERVIEW:  On July 2, 2014, the Centers for Medicare & Medicaid Services (CMS) issued a proposed rule that would update payment policies and rates under the End-Stage Renal Disease (ESRD) Prospective Payment System (PPS) for renal dialysis services furnished to beneficiaries on or after January 1, 2015.  This proposal would introduce new quality and performance measures to improve the quality of care by outpatient dialysis facilities treating patients with end-stage renal disease and proposes to implement the Affordable Care Act mandate to bring more competitive bidding for durable medical equipment. 

 

The rule also proposes changes to the ESRD Quality Incentive Program (QIP), including for payment year (PY) 2017 and PY 2018, under which payment incentives are applied to dialysis facilities to improve the quality of dialysis care.  Under the ESRD QIP, facilities that do not achieve a minimum total performance score with respect to quality measures established in regulation receive a reduction in their payment rates under the ESRD PPS. This rule also addresses issues related to the coverage and payment of durable medical equipment, prosthetics, orthotics, and supplies (DMEPOS).

PROPOSED CHANGES REGARDING DURABLE MEDICAL EQUIPMENT, PROSTHETICS, ORTHOTICS, AND SUPPLIES (DMEPOS) FOR CY 2015:

Propose the methodology for making national price adjustments based upon information gathered from the DMEPOS Competitive Bidding Program:   This rule proposes methodologies to implement the use of information from the DMEPOS CBP to adjust the fee schedule amounts for DME in areas where competitive bidding programs (CBPs) are not implemented.  The major provisions in this proposal are:

  •  Adjust fee schedule amounts for states in different regions of the country based on competitive bidding pricing from competitions in these regions.  The regional prices would be limited by a national ceiling (110% of the average of regional   prices) and floor (90% of the average of regional prices)
  •   Use national ceiling as adjusted fee for states that are predominantly rural or sparsely populated (frontier states).
  •   Adjust fee schedule amounts for non-contiguous areas based on the average of competitive bidding pricing from these areas or the national ceiling, whichever is higher.

Propose phase in of special payment rules in a limited number of areas under the CBP for certain DME and enteral nutrition:  This rule proposes a limited phase in of bundled monthly payment amounts for the equipment, supplies, accessories and any necessary maintenance and repairs for enteral nutrition, oxygen and oxygen equipment, standard manual wheelchairs, standard power wheelchairs, hospital beds, continuous positive airway pressure devices and respiratory assist devices furnished under the CBP in place of capped rental policies. Extending the use of these payment rules to additional competitive bidding areas and/or items would be addressed through future notice and comment rulemaking.

Clarification of the statutory Medicare hearing aid coverage exclusion stipulated at Section 1862(a)(7)This rule proposes to codify the specific exceptions when a device could be considered a prosthetic device and not subject to the hearing aid exclusion.

Update the definition of minimal self-adjustment of orthotics at 42 CFR §414.402:  This rule proposes to update the regulation to reflect program guidance on what specialized training is needed to provide custom fitting services if providers are not certified orthotists.

Change of Ownership Rules to Allow Contract Suppliers to Sell Specific Lines of Business:  Current rules prohibit the sale of a competitive bidding contract.  However, CMS may permit the transfer of a contract to an entity that merges with or acquires a competitive bidding contract supplier if the new owner assumes all rights, obligations, and liabilities of the competitive bidding contract. This proposed rule would establish an exception to the prohibition against subdividing a contract that would allow a contract supplier to sell a distinct company (e.g., an affiliate or subsidiary) which furnishes a specific product category (PC) or a specific competitive bidding area (CBA).  Under this exception, CMS would sever the CBAs and PCs that the company serves, along with that company’s location(s), from the original contract; incorporate those CBAs, PCs, and locations into a new contract; and transfer the contract to a new owner under specific circumstances.  This change to the regulation would apply to all current and future rounds.

CMS will accept comments on the proposed rule until September 2, 2014.  The proposed rule will appear in the July 11, 2014 Federal Register and can be downloaded from the Federal Register at: http://www.ofr.gov/inspection.aspx?

 

February 24, 2014

Hill Notification: CMS Seeks Input on Next Phase of Competitive Bidding Implementation

The Centers for Medicare and Medicaid Services (CMS) released an Advanced Notice of Proposed Rulemaking (ANPRM) seeking public comment regarding nationwide implementation of the Medicare Durable Medical Equipment, Prosthetics, Orthotics, and Supplies (DMEPOS) Competitive Bidding Program.

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 country. By 2016, Medicare must implement competitive bidding or competitive bidding pricing for included items to non-competitive bidding areas.

While the methodology will be proposed in future rulemaking, CMS is requesting comments on several aspects that it would consider in developing a methodology to adjust DMEPOS fee schedule amounts or other payment amounts in non-competitive bidding areas based on DMEPOS competitive bidding payment information.  

In addition, CMS is requesting ideas for potentially simplifying the payment rules and enhancing beneficiary access to items and services under the competitive bidding programs for certain durable medical equipment and enteral nutrition.  CMS is seeking input in several areas, including lump sum purchases and capped rental payment rule.