cms072009

							MEDICARE DURABLE MEDICAL
EQUIPMENT, PROSTHETICS, ORTHOTIC
S, AND SUPPLIES (DMEPOS)
COMPETITIVE BIDDING PROGRAM
ROUND 1 REBID

- What You Need to Know!




 Webinar Presentation – July 2009
What is DMEPOS?
 DMEPOS   stands for
   Durable Medical Equipment
   Prosthetics
   Orthotics
   Supplies
 Equipmentand supplies covered under
 Medicare Part B
DMEPOS Facts
 Medicare pays  for durable medical equipment
  (DME) used in the home.
 Some examples of DME include oxygen equipment,
  walkers, wheelchairs, devices used to treat sleep
  disorders, and hospital beds.
 Over 9 million beneficiaries use DME each year.

 Total allowed charges for DMEPOS in 2008 were
  $14.6 billion.
 DMEPOS represents approximately 6 percent of
  Part B expenditures.
Current DMEPOS Payment Methodology
 As required by the Medicare law, Medicare has
  paid for most DME on a fee schedule basis since
  January 1, 1989.
 Any qualified, enrolled supplier can furnish
  DMEPOS.
 Medicare pays 80 percent of the lesser of the
  actual charge for the item or the fee schedule
  amount for the item; the beneficiary pays the
  remaining 20%.
What is Competitive Bidding?
 Competitive Bidding is a way to help Medicare pay
  appropriately for DMEPOS.
 DMEPOS  suppliers submit bids for selected
  DMEPOS products in selected areas; Medicare’s
  payments will be based on bids.
                    that submit competitive bids
 Qualified suppliers
  are offered Medicare contracts.
What is Competitive Bidding?
 When   the program goes into effect, beneficiaries
  who live in or visit competitive bidding areas will
  need to use Medicare contract suppliers in most
  situations to buy or rent competitively bid DMEPOS
  equipment or supplies for Medicare to pay.
 Under the new program, Medicare’s DMEPOS
  payment rates will be less, so a beneficiary’s 20%
  coinsurance payments will be less too.
What Are the Benefits?
 Beneficiary and   taxpayer costs are reduced as a
  result of overall competitive bidding program
  savings.
 Competitive bidding creates incentives for
  DMEPOS suppliers to provide high quality products
  and services to Medicare beneficiaries efficiently at
  a reasonable cost.
What Are the Benefits?
 Competitive bidding ensures a sufficient number of
  DMEPOS suppliers is available to meet the
  expected demand for a product in each
  competitive bidding area.
 Competitive bidding   requires DMEPOS suppliers to
  meet certain quality and financial standards that
  reduce fraud in the Medicare program while
  establishing fair, market-based prices.
History of Competitive Bidding
    new program builds on successful
 The
 demonstrations.
 TheMedicare Prescription Drug, Improvement,
 and Modernization Act of 2003 mandated the
 development and implementation of the program.
 The   program was in place briefly in 2008.
 OnJuly 15, 2008, the Medicare Improvements for
 Patients and Providers Act of 2008 (MIPPA),
 delayed the program and made limited changes.
   Competitive Bidding - MIPPA Changes

             MIPPA Changes                                    Results
Delayed program and requires Round 1         Allows time to make additional
Rebid competition in 2009 in nearly all of   refinements to the competitive bidding
the same areas for most of the same          program.
items that were included in 2008. Later
Rounds of the program also delayed.
Establishes a process to give suppliers      Suppliers that submit documents timely
feedback on missing financial documents      will have the opportunity to submit
required to be submitted with bids.          missing financial documents.
Requires contract suppliers to notify        Helps Medicare ensure that quality
Medicare of subcontracting relationships     products and services are being provided.
and that each subcontractor meets
supplier accreditation requirements.
Provides limited exemption to the            Hospitals that only furnish walkers during
competitive bidding program for              inpatient stay or upon discharge don’t
hospitals.                                   have to bid.
Who will be Affected?
 Theprogram will affect beneficiaries who have
 Original Medicare and who
   Permanently live in a competitive bidding area or
   Obtain competitively bid items while visiting a
    competitive bidding area.
 Medicare Advantage  enrollees can use suppliers
 designated by their plan.
Where are the Round 1 Rebid Areas?
 Cincinnati   – Middletown (Ohio, Kentucky and
  Indiana)
 Cleveland – Elyria – Mentor (Ohio)

 Charlotte – Gastonia – Concord (North Carolina
  and South Carolina)
 Dallas – Fort Worth – Arlington (Texas)

 Kansas City (Missouri and Kansas)

 Miami – Fort Lauderdale – Miami Beach (Florida)
Where are the Round 1 Rebid Areas?
 Orlando  (Florida)
 Pittsburgh (Pennsylvania)

 Riverside – San Bernardino – Ontario (California)
What are the Round 1 Rebid Products?
 Oxygen and  Oxygen equipment
 Standard Power Wheelchairs, Scooters, and
  Related Accessories
 Complex Rehabilitative Power Wheelchairs and
  Related Accessories (Group 2)
 Mail-Order Diabetic Supplies

 Enteral Nutrients, Equipment and Supplies
What are the Round 1 Rebid Products?
 Continuous  Positive Pressure Airway Devices and
  Respiratory Assist Devices and Related Accessories
 Hospital Beds and Related Accessories
 Walkers and Related Accessories

 Support surfaces (e.g., powered mattresses) –in
  Miami only
What is Grandfathering?
 Beneficiaries who   are currently renting DMEPOS
  products from noncontract suppliers may choose
  to continue to rent from the same supplier until
  their rental agreement expires if that supplier
  decides to become a grandfathered supplier.
 Suppliers will provide advance notification to the
  beneficiary to tell them they have not been
  awarded a contract and whether they will continue
  furnishing the items as a grandfathered supplier or
  will no longer furnish the item.
What is Grandfathering?
         suppliers and noncontract suppliers will
 Contract
 work together to ensure a smooth transition.
Beneficiary Protections
 Competitive bidding   ensures a sufficient number of
  qualified DMEPOS suppliers is available to meet
  the expected demand for a product in each
  competitive bidding area. Additional contract
  suppliers can be added at any time if necessary.
 Contract suppliers must furnish the item to any
  beneficiary in the area that comes to them
  regardless of where they live, and the supplier
  must accept the Medicare payment as payment in
  full (mandatory assignment).
Beneficiary Protections
A  physician authorization process ensures that the
  beneficiary will receive a particular brand product
  or mode of delivery if their physician determines
  that it is needed to avoid an adverse medical
  outcome.
 Contract suppliers must furnish the same range of
  products to Medicare beneficiaries that they
  furnish to other customers and must report on the
  products they furnish on a quarterly basis.
When will Competitive Bidding
Affect People with Medicare?
 Medicare will  begin the supplier bidding process
  soon, but there will be no immediate impact on
  Medicare beneficiaries.
 People with Medicare can continue to get their
  Medicare-covered equipment and supplies from
  any Medicare-approved supplier until the program
  begins again in 2011.
 Medicare is planning an intense beneficiary and
  referral agent education campaign in 2010.
Questions?
 1-800-MEDICARE (1-800-633-4227),   TTY users
  should call 1-877-486-2048
 www.medicare.gov

 www.cms.hhs.gov/DMEPOSCompetitiveBid