DMEPOS

The Durable Medical Equipment, Prosthetics, Orthotics, and Supplies (DMEPOS) Competitive Bidding Program

Competitive Bidding—A Better Way to Pay

Started in January 2011 for certain durable medical equipment, prosthetics, orthotics, and supplies (DMEPOS) in 9 areas of the country (Round 1)

In July 2013 • The program expanded to more areas (Round 2)• The National Mail-Order Program was implemented

Limits fraud and abuse in the Medicare program The Competitive Bidding Program helps people with

Medicare• Save money• Get quality equipment, supplies, and services

October 2015 Competitive Bidding Program 2

The Competitive Bidding Program

Suppliers submitted bids to provide certain DMEPOS at lower prices than Medicare was paying

Contracts are awarded to winning suppliers to sell/rent DMEPOS

Amount Medicare pays for DMEPOS is based on bids

• When Medicare pays less, the 20% coinsurance is less Contract suppliers must• Meet eligibility, quality, and financial standards

• Be accredited by an independent organization

October 2015 Competitive Bidding Program 3

The Competitive Bidding Program—Continued

In most cases, only contract suppliers can• Provide competitively bid DMEPOS

The types of items Medicare covers doesn't change

Contract supplier charge can’t exceed single payment amount based on bids received for an item

October 2015 Competitive Bidding Program 4

Round 1 Recompete Products1/1/14-12/31/16

Products Included in Round 1 RecompeteRespiratory equipment and related supplies and accessories including Oxygen, oxygen equipment and supplies; Continuous Positive Airway Pressure (CPAP) devices and respiratory assist devices (RADs) and related supplies and accessories; and standard nebulizers

Standard mobility equipment and related accessories including Walkers, standard power and manual wheelchairs, scooters, and related accessoriesGeneral home equipment including Hospital beds and related accessories, group 1 and 2 support surfaces, transcutaneous electrical nerve stimulation (TENS) devices, commode chairs, patient lifts, and seat liftsEnteral nutrients, equipment, and supplies

Negative pressure wound therapy pumps and related supplies and accessories

External infusion pumps and supplies

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Round 1 Recompete—2017

The law requires contracts to recompete at least once every 3 years

Current period expires on December 31, 2016 Contracts for next period to become effective

on January 1, 2017

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Round 2 Competitive Bidding

Contract and prices • Were effective on July 1, 2013• Expire June 30, 2016

Program will expand• 91 Metropolitan Statistical Areas

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Products Included in Round 2*

Products Included in Round 2

Oxygen, oxygen equipment, and supplies

Enteral nutrients, equipment, and supplies

Continuous Positive Airway Pressure (CPAP) devices and 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)

Standard (power and manual) wheelchairs, scooters, and related accessories

Negative pressure wound therapy pumps and related supplies and accessories

*Changes from Round 1 to Round 2 in Bold ItalicsOctober 2015 Competitive Bidding Program 8

National Mail-Order Program for Diabetic Testing Supplies

Designed to ensure that people with Original Medicare continue to get quality supplies and save money • People who choose to have diabetic testing supplies

delivered to their home need to know Medicare won't pay unless a national mail-order contract

supplier is used National mail-order contract suppliers can’t charge more

than the deductible and 20% coinsurance• People can also choose to get supplies from any local store

Local stores can’t charge more than the deductible and 20% coinsurance if they accept assignment

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The Competitive Bidding Program— Who will be Affected?

People who have Original Medicare and• Permanently reside in, or are visiting, a Competitive

Bidding Area (CBA) and obtain competitively bid items To find out if a ZIP code is in a CBA or to locate a

contract supplier• Visit Medicare.gov/supplier, or • Call 1-800-MEDICARE (1-800-633-4227)

TTY users call 1-877-486-2048 Medicare Advantage Plans should let their enrollees know

if their plan is changing

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Round 2 Recompete & National Mail-Order Recompete

Round 2 and National Mail-Order Program• Contract periods expire on June 30, 2016

Round 2 Recompete and the national mail-order Recompete contracts • Become effective on July 1, 2016 • Expire on December 31, 2018

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Doctors and Other Treating Practitioners Use of Contract Suppliers

Must almost always use contract supplier if• Items and services are included in Competitive Bidding

Program where a person with Original Medicare lives• Someone is traveling to or visiting a competitive bidding

area Doctors, treating practitioners, and hospitals can

supply certain items (e.g.: walkers and folding manual wheelchairs) without being contract suppliers

A nursing facility can supply directly to its own residents only if it becomes a contract supplier

October 2015 Competitive Bidding Program 12

Staying With A Non-Contract Supplier

A consumer can stay with current supplier that doesn’t have a new contract, provided that• Supplier elects to become “grandfathered” • The person with Original Medicare permanently

resides in a competitive bidding area (CBA)• The person with Original Medicare was renting

certain equipment or oxygen when the program (or recompeted round) started

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Grandfathering

Non-contract supplier• Must inform Medicare consumers in writing about

whether they’ll continue renting equipment• Works with contract supplier to get new equipment

if Medicare consumers switch to a contract supplier The choices are• Continue getting services from a grandfathered

supplier until rental period ends OR• Switch to a new contract supplier

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Have Other Insurance?

Medicare may make payment to a non-contract supplier if required by primary policy

Non-contract supplier must • Be accredited• Have a valid Medicare billing number• Be eligible to receive secondary payments

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Non-contract Supplier

A non-contract supplier generally may not provide competitively bid items in a competitive bidding area

If a non-contract supplier is used and no exception applies, people with Medicare aren’t responsible for payment unless the supplier issues an Advance Beneficiary Notice (ABN)• By signing the ABN, the person with Medicare

agrees to pay entire amount

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Changing Suppliers Scenario

Obtaining DMEPOS items from a new contract supplier

Mildred’s permanent residence is in Miami, FL, which is a Round 1 Competitive Bidding Area. She’s currently renting her Continuous Positive Airway Pressure (CPAP) device from ABC Company, which has a 2016 Round 1 Recompete contract, but not a 2017 Round 1 Recompete contract. Mildred receives a notice from ABC Company informing her that they won’t be a contract supplier after December 31, 2016, and that they also won’t be a grandfathered supplier starting January 1, 2017. Mildred must transition to a Round 1 Recompete contract supplier for Medicare to help pay.

October 2015 Competitive Bidding Program 17

Getting DMEPOS When Travelling

To Competitive Bidding Areas (CBAs)• Must generally use contract supplier for that CBA• If non-contract supplier used and no exception

applies, people with Medicare aren’t responsible for payment unless supplier issues Advance Beneficiary Notice

To non-competitive bidding areas• Can use any Medicare-enrolled supplier

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Specific Brands

Doctor must prescribe in writing Medical record must reflect need Contract supplier must • Provide the specific brand or form as prescribed

OR• Work with the doctor or treating practitioner to

find a suitable alternative and obtain a revised prescription OR

• Help locate another contract supplier that can Provide the specific brand or form as prescribed

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Equipment Repair & Replacement

For owned medical equipment• Any Medicare-enrolled supplier can make

necessary repairs• For replacement, must use a contract supplier • For warranty repairs, follow the warranty rules

For rented equipment• Repairs are included in rental payment—the

supplier must fix at no charge

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Deductible and Coinsurance

After paying the annual Part B deductible• Medicare pays 80% of the Medicare-approved amount for

equipment, supplies, and services• The consumer is responsible for 20% coinsurance

Contract suppliers can’t bill for more than these amounts

For suspected overpayment or fraud, call • 1-800-MEDICARE (1-800-633-4227)

TTY users call 1-877-486-2048• Fraud Hotline of the HHS Office of Inspector General at

1-800-447-8477October 2015 Competitive Bidding Program 21

Points to Remember

The Competitive Bidding Program does NOT affect which doctors or hospitals a person with Medicare can use

Generally, a contract supplier must be used for Medicare to help pay

A person with Medicare may be able to stay with their current supplier if renting from a supplier who has a new contract or elects to become “grandfathered”

People in Medicare Advantage Plans should check with the plan

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Resources

Visit Medicare.gov/supplierdirectory/search.html • DMEPOS Supplier Locator Tool

Visit Medicare.gov/supplier• Consumer information

Call 1-800-MEDICARE (1-800-633-4227) • TTY users should call 1-877-486-2048

Doctors or suppliers Medicare’s local information resources• State Health Insurance Assistance Programs• Administration for Community Living

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CMS National Training Program (NTP)

To view all available NTP training materials, or to subscribe to our email list, visit

CMS.gov/Outreach-and-Education/Training/ CMSNationalTrainingProgram/index.html

For questions about training products email training@cms.hhs.gov