On August 19, 2011, the Centers for Medicare & Medicaid Services (CMS) announced the next steps for the expansion of the Durable Medical Equipment, Prosthetics, Orthotics, and Supplies (DMEPOS) competitive bidding program (namely, Round Two and the national mail-order competition). CMS' announcement: (1) geographically expands the DMEPOS competitive bidding program to include one hundred competitive bidding areas (CBAs) in Round Two; (2) adds additional DMEPOS items and categories to the bidding; and (3) introduces a national mail-order competitive bidding program for diabetic testing supplies.
Under the DMEPOS competitive bidding program, DMEPOS suppliers compete by submitting bids to furnish certain DMEPOS items in CBAs. The process results in lower reimbursement rates compared with the existing fee-for-service schedule for the DMEPOS items subject to competitive bidding (approximately 35% lower according to CMS). The DMEPOS competitive bidding program is currently in effect in nine CBAs; the announcement adds an additional ninety-one CBAs. Although some of the expansion was required under the Medicare Improvements for Patients and Providers Act, the DMEPOS competitive bidding program was further expanded by the Patient Protection and Affordable Care Act (PPACA), which mandates that, by 2016, all areas of the country will be subject to either the DMEPOS competitive bidding program or payment rate adjustments using competitively bid rates.
At the same time as the Round Two competition, CMS will conduct a national mail-order competition for diabetic testing supplies. The national mail-order competition will include all fifty states, the District of Columbia, Puerto Rico, U.S. Virgin Islands, Guam, and American Samoa.
CMS expanded the list of Round Two DMEPOS items by: (1) combining standard manual wheelchairs, standard power wheelchairs, and scooters to form a new expanded standard mobility device product category; (2) expanding bidding for support surfaces throughout all Round Two areas; and (3) adding negative pressure wound therapy pumps and related supplies and accessories as an additional product category.
Round Two Categories of DMEPOS Items
CMS' Implementation Schedule for Round Two
A list of zip codes included in Round Two and a list of the specific items in each product category are available on the Competitive Bidding Implementation Contractor website. The DMEPOS Round Two Fact Sheet is available online.
Copyright 2011 American Health Lawyers Association, Washington, DC. Reprint permission granted.