CMS: NEW MEDICAL EQUIPMENT PROGRAM OFFERS VALUE FOR MEDICARE BENEFICIARIES

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Details for: NEW MEDICAL EQUIPMENT PROGRAM OFFERS VALUE FOR MEDICARE BENEFICIARIES
For Immediate Release:	Wednesday, February 16, 2011
Contact:	CMS Office of Public Affairs 202-690-6145

NEW MEDICAL EQUIPMENT PROGRAM OFFERS VALUE FOR MEDICARE BENEFICIARIES

Competitive bidding program focuses on providing access to high quality products and services for people with Medicare

The Centers for Medicare & Medicaid Services (CMS ) launched the first phase of the Durable Medical Equipment, Prosthetics, Orthotics, and Supplies (DMEPOS) Competitive Bidding Program on January 1, 2011, in nine different areas of the country.

Through supplier competition, the program set new, lower payment rates for certain medical equipment and supplies, such as oxygen equipment, certain power wheelchairs and mail order diabetic supplies. CMS estimates that Medicare and beneficiaries will pay 32 percent less on average for these equipment and supplies. In most cases, Medicare beneficiaries who obtain these items in the nine competitive bidding areas will need to get them from the Medicare suppliers that were awarded contracts in order to have the items covered under Medicare. More than four million Medicare beneficiaries living in the nine competitive bidding areas can save money through this new program, while continuing to have access to quality medical equipment from accredited suppliers they can trust.

“We are pleased to report that implementation of the program is going very smoothly,” said CMS Administrator Donald Berwick, M.D. “We continue to deploy a wide array of resources across all of the competitive bidding areas to address any concerns that may arise.”

These resources include local State Health Insurance and Assistance Program (SHIP) offices, specially trained customer service representatives at 1-800-MEDICARE, and caseworkers in Medicare’s regional offices who all stand ready to assist beneficiaries who may have questions about the program. In addition, there is a complaint and inquiry process for beneficiaries, caregivers, doctors, referral agents and suppliers to use for reporting concerns about a contract supplier or other competitive bidding implementation issues. This process is designed to ensure that all complaints are correctly routed, investigated, resolved, tracked and reported. Further, there is a Competitive Acquisition Ombudsman who will respond to complaints and inquiries from suppliers and others about the application of the program and issue an annual Report to Congress.

Since the beginning of the program, CMS has received only a handful of beneficiary complaints and has acted quickly to resolve each one. While 1-800 MEDICARE has received a number of inquiries about the program, the majority of such inquiries are on routine matters, such as selecting a supplier.

“CMS continues to monitor the implementation of the program very carefully” said Dr. Berwick. “We urge all stakeholders to bring any issues to our attention in order for our caseworkers to resolve them as quickly as possible.”

Program monitoring includes the use of beneficiary surveys, active claims surveillance and analysis, contract supplier reporting, and tracking and analysis of complaints and inquiries in the nine initial areas, which include Charlotte, Cincinnati, Cleveland, Dallas, Kansas City, Miami, Orlando, Pittsburgh and Riverside. CMS has taken administrative actions against a small number of contract suppliers to help bring them back into compliance with Medicare’s rules.

Only the following categories of items are included in the first phase of this program:

• Oxygen, Oxygen Equipment, and Supplies

• Standard Power Wheelchairs, Scooters, and Related Accessories

• Complex Rehabilitative Power Wheelchairs and Related Accessories (Group 2 only)

• Mail-Order Diabetic Supplies

• Enteral Nutrients, Equipment and Supplies

• Continuous Positive Airway Pressure (CPAP) Devices, Respiratory Assist Devices (RADs), and Related Supplies and Accessories

• Hospital Beds and Related Accessories

• Walkers and Related Accessories

• Support Surfaces (Group 2 mattresses and overlays in Miami-Ft. Lauderdale-Pompano

Beach, FL only)

The Medicare DMEPOS Competitive Bidding Program was established by the Medicare Prescription Drug, Improvement, and Modernization Act of 2003, and the program was briefly implemented in 2008 in 10 areas before it was temporarily delayed. The Medicare Improvements for Patients and Providers Act of 2008 (MIPPA), enacted on July 15, 2008, terminated the supplier contracts in effect at the time, temporarily delayed the program, and made certain limited changes to the program. MIPPA also required CMS to conduct the competition again for Round One in 2009, and delayed competition for Round Two in 70 additional metropolitan statistical areas (MSAs) until 2011 and in additional areas of the country until after 2011. The Affordable Care Act of 2010 expands the number of Round Two MSAs from 70 to 91 areas.