Proposed rule: Current bid contracts won’t be extended

Rule also proposes adjustments to fee schedule methodology, establish separate payment class for oxygen
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Wednesday, July 11, 2018

WASHINGTON – A proposed rule released today seeks to make changes to the Medicare fee schedule and the competitive bidding program.

The most surprising change: When current bidding contracts expire Dec. 31, 2018, beneficiaries will be able to obtain DMEPOS items from any enrolled supplier until new contracts are awarded.

However, the process for the next round of the bidding program has not yet been initiated and CMS said it will issue that information at a later date.

The proposed rule is contained in the CY 2019 Changes to the End-Stage Renal Disease Prospective Payment System.

HME stakeholders predicted the rule, which was originally expected to be released at the end of June, would be a vehicle for bid-related changes.

“Today’s proposals will help secure sustainable access to durable medical equipment,” said CMS Administrator Seema Verma, in a press release.

The rule proposes to:

  • Revise the DMEPOS CBP by implementing lead item pricing.
  • Revise the definition of composite bid to mean the bid submitted by the supplier for the lead item in the product category.
  • Establish a new method for establishing single payment amounts under the CBP using maximum winning bids.
  • Establish three different temporary fee schedule adjustment methodologies depending on the area in which the items and services are furnished. Those methodologies are as follows:
  • Three different fee schedule adjustment methodologies depending on area in which items and services are furnished: (1) one fee schedule adjustment methodology for DME items and services furnished on/after Jan. 1, 2019, in areas currently CBAs, in event of gap in the CBP; (2) another fee schedule adjustment methodology for items and services furnished from Jan. 1, 2019, through Dec. 31, 2020, in areas that are currently not CBAs, are not rural areas, and are located in the contiguous United States (U.S.); and (3) another fee schedule adjustment methodology for items and services furnished from Jan. 1, 2019, through Dec. 31, 2020, in areas that are currently not CBAs and are either rural areas or non-contiguous areas.

 

The rule also seeks to:

  • Establish new, separate payment classes for portable gaseous, portable liquid, and high flow portable liquid. It also proposes to establish new methodology for ensuring that all new classes for O2 and equipment are budget neutral.
  • Establish new rules to address payment for certain vents that are subject to payment rules but also perform functions of other items of DME that are subject to payment rules.

View the proposed rule.

View related fact sheet.

 

Comments

Page 241 has my blood boiling!! "As a supplier increases their volume [of customers], the costs associated with labor, delivery, and overhead also increase proportionally."

I guess somebody should tell Walmart and Amazon that their business model is doomed!