Fact Sheets
MEDICARE ANNOUNCES TIMELINE, STARTS BIDDER EDUCATION FOR DURABLE MEDICAL EQUIPMENT, PROSTHETICS, ORTHOTICS, AND SUPPLIES
MEDICARE ANNOUNCES TIMELINE, STARTS BIDDER EDUCATION FOR DURABLE MEDICAL EQUIPMENT, PROSTHETICS, ORTHOTICS, AND SUPPLIES
COMPETITIVE BIDDING PROGRAM ROUND 2 AND NATIONAL MAIL-ORDER COMPETITIONS
The Centers for Medicare & Medicaid Services (CMS) has announced the detailed bidding schedule for the Round 2 and National Mail Order competitions of the Medicare Durable Medical Equipment, Prosthetics, Orthotics and Supplies (DMEPOS) Competitive Bidding Program. The program was expanded by the Affordable Care Act and is estimated to save Medicare, seniors, and taxpayers $28 billion over 10 years. Already in 2011, the first phase of the program has saved Medicare 35 percent compared to the fee schedule and resulted in lower cost for Medicare patients.
To ensure that suppliers have ample time to prepare for the bidding process, CMS began a pre-bidding supplier awareness campaign in August 2011. CMS has now launched a comprehensive bidder education program leading up to the bidding period, which is scheduled to begin in late January of 2012.
Suppliers can get information about the competitive bidding program by going to www.dmecomptitive bid.com or by calling the toll-free help desk at 1-877-577-5331.
The Medicare DMEPOS Competitive Bidding Program was established by the Medicare Prescription Drug, Improvement, and Modernization Act of 2003 (“Medicare Modernization Act” or “MMA”) after the conclusion of successful demonstration projects. Under the MMA, the DMEPOS Competitive Bidding Program was to be phased in so that competition under the program would first occur in 10 areas in 2007. The Medicare Improvements for Patients and Providers Act of 2008 (MIPPA) temporarily delayed the program in 2008 and made certain limited changes. As required by MIPPA, CMS conducted the supplier competition again in nine areas in 2009, referring to it as the Round 1 Rebid.
The Round 1 Rebid contracts and prices became effective on January 1, 2011. CMS deployed a wide range of resources to monitor the program, including beneficiary surveys, active claims surveillance and analysis, contract supplier reporting, and tracking and analysis of complaints and inquiries. To date, monitoring data have shown a successful implementation with very few complaints and no changes in beneficiary health status resulting from the program. Health outcomes data are available on the CMS website at: www.cms.gov/DMEPOSCompetitiveBid/
MIPPA delayed the competition for Round 2 from 2009 to 2011 in 70 additional metropolitan statistical areas (MSAs), and authorizes national mail order competitions after 2010. The Affordable Care Act of 2010 (ACA) expands the number of Round 2 MSAs from 70 to 91 and mandates all areas of the country are subject either to DMEPOS competitive bidding or payment rate adjustments using competitively bid rates by 2016.
This program is an essential tool to help Medicare set appropriate payment rates for DMEPOS items and services. Except in the nine areas of the country where the program is now in effect, Medicare pays for DMEPOS items using a fee schedule that is generally based on historic supplier charges from the 1980s, increased by an annual covered item update factor. The program replaces the existing outdated, excessive fee schedule amounts with market-based prices. Under the program, DMEPOS suppliers compete to become Medicare contract suppliers by submitting bids to furnish certain items in competitive bidding areas (CBAs). The new, lower payment amounts resulting from the competition replace the fee schedule amounts for the bid items in these areas.
The overall savings to Medicare and beneficiaries as a result of the DMEPOS competitive bidding program is expected to total more than $28 billion over the first ten years of the program, according to the CMS Office of the Actuary. The $28 billion savings comes from a combination of savings of more than $17 billion in Medicare expenditures, and savings of over $11 billion for beneficiaries as a result of lower coinsurance payments and the downward effect on monthly premium payments.
TIMELINE
CMS has announced the following bidding schedule timeline for the program:
11/30/2011
The Centers for Medicare & Medicaid Services (CMS) begins bidder education program
12/5/2011*
Registration for user IDs and passwords begins
1/30/2012*
CMS opens 60-day bid window for Round 2 and National Mail-order Competitions
2/29/2012*
Covered Document Review Date for bidders to submit financial documents
3/30/2012*
60-day bid window closes
Fall 2012*
CMS announces single payment amounts, begins contracting process
Spring 2013*
CMS announces contract suppliers, begins contract supplier education campaign
Spring 2013*
CMS begins supplier, referral agent, and beneficiary education campaign
July 1, 2013*
Implementation of Medicare DMEPOS Competitive Bidding Program Round 2 and National Mail-order Competition contracts and prices
*Target date.
BIDDER eDUCATION PROGRAM
The CMS Competitive Bidding Implementation Contractor (CBIC) will be the focal point for bidder education. The CBIC has a dedicated website, www.dmecompetitivebid.com, which will include a comprehensive array of important information for suppliers, including bidding rules, webcasts, user guides, policy fact sheets, checklists, and bidding information charts. In addition to viewing the information on the CBIC website, DMEPOS suppliers are encouraged to call the CBIC toll-free help desk with their questions and concerns.
The bidder education program will feature numerous enhancements such as the improved Request for Bids instructions, updated fact sheets, and a series of educational webcasts. These webcasts will be available 24 hours a day on the CBIC web site to ensure maximum opportunities for suppliers to access the information.
CMS will send listserv announcements in order to disseminate key information about registration and bidding to suppliers and encourages all suppliers interested in bidding to visit the CBIC website now to sign up to receive these announcements.
PRODUCT CATEGORIES
The Round 2 product categories are:
- Oxygen, oxygen equipment, and supplies
- Standard (Power and Manual) wheelchairs, scooters, and related accessories
- Enteral nutrients, equipment, and supplies
- Continuous Positive Airway Pressure (CPAP) devices and Respiratory Assist Devices (RADs) and related supplies and accessories
- Hospital beds and related accessories
- Walkers and related accessories
- Negative Pressure Wound Therapy pumps and related supplies and accessories
- Support surfaces (Group 2 mattresses and overlays)
After consideration of feedback from stakeholders, CMS has removed ultra lightweight manual wheelchairs, gimbaled ventilator trays, and push activated power assist devices from the standard wheelchair product category for Round 2. CMS expects to phase in these items in a future round.
CMS will also be conducting a national mail order competition for diabetic testing supplies at the same time as the Round 2 competition.
IMPORTANT REMINDERS FOR SUPPLIERS INTERESTED IN BIDDING
Suppliers wishing to bid in Round 2 or the National Mail-Order competition should be taking steps to prepare for these competitions. Suppliers interested in bidding are responsible for ensuring that certain key information in their enrollment files at the National Supplier Clearinghouse (NSC) is up-to-date and that they obtain all required state licenses for the items, and in the areas, for which they wish to bid. Any enrollment updates or required licenses not already on file with the NSC should be submitted right away. Suppliers interested in bidding for a product category for which they are not currently accredited must take action immediately to get accredited for that product category. Only suppliers in good standing that have all required licenses and are properly accredited can be awarded a contract.
ADDITIONAL INFORMATION
For additional information about the Medicare DMEPOS Competitive Bidding Program, please visit: http://www.cms.hhs.gov/DMEPOSCompetitiveBid/
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