A.S.P.E.N. Education Center on the Medicare Competitive Bidding Program 2008
The Centers for Medicare & Medicaid Services (CMS) has selected 325 suppliers in 10 pilot communities across the U.S. to provide durable medical equipment (DME) and supplies to Medicare beneficiaries. The goal is to provide DME and supplies at significantly lower prices than Medicare is currently paying. This program is called the DMEPOS Competitive Bidding Program and will begin on July 1, 2008.
What is DMEPOS?
DMEPOS stands for Durable Medical Equipment, Prosthetics, Orthotics and Supplies covered under Medicare Part B. DMEPOS includes ENTERAL NUTRITION.
Which communities will be affected by DMEPOS on July 1, 2008?
These 10 communities or geographical regions are called Competitive Bidding Areas or CBAs. They are regions within states as outlined below:
- California – Riverside, San Bernardino, Ontario
- Florida - Miami, Fort Lauderdale, Miami Beach
- Florida - Orlando, Kissimmee
- Missouri and Kansas - Kansas City
- North and South Carolina - Charlotte, Gastonia, Concord
- Ohio - Cleveland, Elyria, Mentor
- Ohio, Kentucky, and Indiana - Cincinnati, Middletown
- Pennsylvania - Pittsburgh
- Texas - Dallas-Fort Worth, Arlington
- Puerto Rico--San Juan, Caguas, Guaynabo
An additional 70 geographic areas will join this program in July 2009.
Who will be affected?
The Competitive Bidding Program applies to you if you have Original Medicare (does not apply if you have a Medicare Advantage Plan) and your permanent residence is in a ZIP Code that is part of a Competitive Bidding Area (CBA), or if you get certain items while visiting or traveling to a CBA. Your permanent residence is the address that Social Security has in their records for you. To find out if your ZIP Code is in a Competitive Bidding Areas, call 1-800-MEDICARE or visit www.cms.hhs.gov/DMEPOSCompetitiveBid.
Who are the DMEPOS suppliers?
Medicare states that contracts were awarded to those suppliers who offered the best price; who met Medicare’s eligibility, quality and financial standards; and who are accredited by an independent accrediting organization. These suppliers are called “contract suppliers.”
Why is Medicare doing this?
To lower costs for the Medicare program and for the beneficiaries. This program uses the local, competitive marketplace to lower the costs for certain durable medical equipment, prosthetics, orthotics and supplies (DMEPOS) for Medicare beneficiaries who use Medicare-contracted suppliers to obtain medical items and supplies. Because beneficiaries pay 20 percent coinsurance on the cost of DMEPOS, they will directly benefit from the savings.
What do I or my patients need to do now if I am in one of these areas?
Medicare beneficiaries living in one of the CBAs who have ongoing need for a DMEPOS supplier may need to choose a new supplier if their current supplier is not a contract supplier and they wish to have Medicare continue to cover their equipment and supplies. A beneficiary may, in some situations, also be able to continue to receive certain items from a grandfathered supplier. Grandfathered suppliers are non-contract suppliers that provide certain rented equipment under the terms of the program. However, in some cases this may mean that the patient will be required to change suppliers! If a patient is presently receiving enteral nutrition under Medicare, they need to check with their present provider to see if they will be able to continue to be with that provider.
Consumers, physicians and other providers can find a list of Medicare contract suppliers in the 10 initial areas of the program by visiting www.cms.hhs.gov/DMEPOSCompetitiveBid under Search Tools" select "Find Suppliers of Medical Equipment in Your Area) or by calling 1-800-MEDICARE (TTY users should call 1-877-486-2048). People can also visit the local offices of the various partner groups, such as their State Health Insurance and Assistance Program, Area Office on Aging and a number of community organizations that can provide information on the program.
Additional information on the DMEPOS competitive bidding program is available at www.cms.hhs.gov/DMEPOSCompetitiveBid.
What if I have a problem after July 1, 2008?
Contact www.cms.hhs.gov/DMEPOSCompetitiveBid, your supplier, and/or your healthcare provider. A.S.P.E.N. is developing a reporting mechanism for collecting data on problems that patients or clinicians experience related to this program and enteral nutrition. This will be an online data collection tool only and these concerns will be collated and shared with Medicare and local legislators to help improve the program.
Other related links:
Oley Foundation: www.oley.org
National Home Infusion Association www.nhianet.org