Home Medical Equipment Providers in the Round 1, ten Competitive Bidding Areas (CBA)s, were inundated with calls yesterday by confused patients, caregivers, guardians, doctor's offices and other healthcare providers. With just a week before the scheduled start of the program, Medicare finally released a packet with the names of the "Contract Suppliers" for the different categories of Home Medical Equipment affected by the program.

Although most patients received letters over three weeks ago by "Non-Winning" Providers explaining the ability to stay with and continue receiving certain services by a "Grandfathered" supplier, most patients and caregivers either forgot or did not understand the implications of the "Grandfathering" process. That is typical when you are dealing with geriatrics and a patient base whose average age is between 80 and 90 years old. Adding to the confusion is the fact that many patients have their mail forwarded to a guardian or trustee.

The cover letter, which accompanied the list, has no menion of the ability to be "Grandfathered" with the patient's current supplier. It only states that: "If your current supplier isn't listed, contact them for more information".

The letter also explains, " This new program will save you money and ensure that you continue to get quality medical equipment, supplies and services. It will also limit fraud and abuse in the Medicare Program".

I am not sure how they can "ensure" anything when they awarded contracts to many unlicensed companies with no experience and no physical location in the same State as the Competitive Bidding Areas.

Land of Confusion

When Customer Service personnel at my company instructed guardians and caregivers to verify the information on the www.medicare.gov - Medicare Spotlights
website, they contacted us back and said "There is nothing on the site about Grandfathering".

They are correct. Below is the exact wording from the site, in regards to the program:

Where You Get Your Durable Medical Equipment and Supplies May be Changing.
Medicare covers durable medical equipment, like oxygen, wheelchairs, blood glucose monitors, walkers, and hospital beds needed for use in your home. Medicare also covers supplies necessary for use with this equipment such as test strips used with blood glucose monitors. Medicare is working with suppliers to help you potentially save money on your medically-necessary equipment and supplies. You may have heard that you will have to use certain suppliers in your area to get certain types of Medicare-covered equipment or supplies. Starting in July 2008, this will be true in certain areas of the country.

Round 1
The Centers for Medicare & Medicaid Services (CMS) has announced the contract suppliers for the first round of the Medicare durable medical equipment, prosthetics, orthotics, and supplies (DMEPOS) competitive bidding program. The competitive bidding program will offer beneficiaries in the designated competitive bidding areas (CBAs) access to quality DMEPOS products and services with lower out-of-pocket costs.

One guardian explained, "I wish the website would have less propaganda about how we are saving money and explain how I am supposed to get my mother her equipment under this crazy system"

CLICK to view information on the Medicare.gov website

We also received calls from "Bid Winners" that explained their own patients wanted to leave their company even though they are bid winners in the CBA. The patients thought that since the list of providers were divided by cities that they had to use a provider in that city. The "Bid Winner" explained that since the patient lived in Tamarac, a suburb in North Fort Lauderdale, the patient thought they had to use the Tamarac Oxygen Provider.

According to providers, each patient call typically lasted 5-10 minutes and many providers said that their staff stayed "after hours" to return most of the phone calls they received during the day. One patient asked why CMS listed companies in Jacksonville, which is over 300 miles outside the Miami MSA, and Cincinnati & the City of Industry in California but nothing in their Retirement communities in Coral Springs, FL. They asked why CMS did not choose more local companies.

The providers answered that question by providing the 1-800-MED-ICARE phone number. They also told patients about the current legislation and explained they could voice their opinion to their Representatives and Senators by calling the Capitol Hill Switchboard at (202) 224-3121

CLICK for List of Miami Suppliers -> THEN CHOOSE: "View Adobe PDF"


Ways & Means releases summary of H.R. 6331, decided TODAY
Prepared by the Committee on Ways and Means and Committee on Energy and Commerce Staff 6/23/08

H.R. 6331
THE MEDICARE IMPROVEMENTS FOR PATIENTS AND PROVIDERS ACT:

DELAYING AND REFORMING MEDICARE'S COMPETITIVE BIDDING PROGRAM FOR DURABLE MEDICAL EQUIPMENT

The Medicare Improvements for Patients and Providers Act delays implementation of Medicare's competitive bidding program for durable medical equipment, prosthetics, orthotics, and supplies (DMEPOS). It would also make improvements to the bidding process, establishes quality measures for DME suppliers in Medicare, and makes additional changes to the program. The cost of the delay would be offset by a reduction in current DMEPOS payment rates. This section of the bill is based on the Medicare DMEPOS Competitive Acquisition Reform Act, which was authored by Reps. Stark and Camp.

Medicare pays for most types of DMEPOS items using a traditional fee schedule. The Medicare Prescription Drug, Improvement, and Modernization Act of 2003 (MMA) requires the Centers for Medicare and Medicaid Services to competitively bid a wide range of items, including oxygen equipment, standard and complex power wheelchairs, mail-order diabetic supplies, and continuous positive airway pressure (CPAP) devices. Under the program, suppliers bid to provide items for one or more of the categories in a geographic area. Based on those bids, suppliers are awarded contracts to supply the selected items to beneficiaries; suppliers that are not awarded contracts are precluded from providing Medicare beneficiaries with the competitively bid items in the covered areas.

After the initial round of bidding, many suppliers voiced concern that the rules of the bidding program were unclear, and that many companies were unfairly excluded from the process. In addition, beneficiary advocates indicated that the way the program was being implemented could threaten access to certain items and reduce the quality of goods and services.

Unless legislation is enacted to delay the program, Round 1, which affects 10 metropolitan statistical areas, is slated to start on July 1, 2008. The agency is required to begin implementation of Round 2, which will affect 70 communities, in 2009, although CMS has not released the exact schedule. After Round 2 is completed, competitive bidding may be expanded across the country and prices may be adjusted in non-bid areas using information from the bidding program. H.R. 6331 would make the following changes to the completive bidding program:

· Terminate contracts awarded under Round 1 and restart the bidding and contracting process in those areas in 2009. The bidding process for Round 2 would begin in 2011. Payment adjustments for DMEPOS in non-competitive bid areas would not take effect until Round 2 is completed.

· Require CMS to notify bidders about paperwork discrepancies and give suppliers an opportunity to submit the proper documentation within a reasonable time frame.

· Exempt rural areas and MSAs with a population of less than 250,000 from competitive bidding for at least 5 years. Before using its authority to adjust prices in non-bid areas, CMS must issue a regulation and consider how prices set through competitive bidding compare to costs for such items in non-bid areas.

· Require all suppliers to be accredited by October 1, 2009. Ensure that all suppliers, whether they are billing Medicare directly or are a subcontractor to another supplier, be subject to accreditation. Require contracting suppliers to disclose all subcontracting relationships to CMS.

· Require that suppliers who bid on diabetic testing supplies offer a wide range of brand name products.

· Exclude complex rehabilitation wheelchairs, and related accessories when furnished with such wheelchairs, from competitive bidding. Exclude negative pressure wound therapy from Round 1 and require CMS to evaluate how these items are coded and paid.

· Establish a separate ombudsman within CMS to handle supplier and beneficiary issues related to the competitive bidding program.

The cost of delaying and reforming the program would be completely offset within the DME sector. The legislation would reduce payment rates for certain DMEPOS nationwide by 9.5 percent in 2009. In 2014, payment rates for those items which are not under a contract would be increased by 2 percent, in addition to the regular inflation-based increase they receive. The Congressional Budget Office has certified that the net cost of this section of H.R. 6331 is budget neutral over 5 years and 10 years.

In order to avoid making additional cuts to certain types of DME, the House version of the Medicare Improvements for Patients and Provider Act removes provisions in the Senate bill to reduce payments for oxygen equipment and power wheelchairs.

Members look for emails throughout the day.
Look for a follow-up email which will include advice, sample letters and scripts for talking with patients, caregivers and guardians regarding the new program.