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Medicare May Remove Constraints on DME Supplier Choice
September 18, 2018
Article originally sourced from BNA written by Mindy Yochelson
"Are you a Medicare beneficiary who’s felt limited by your choice of suppliers for durable medical equipment (DME): walkers, standard power and manual wheelchairs, scooters, commode chairs etc.?
Have you wanted to try another supplier but couldn’t because the business wasn’t offered a contract by Medicare and wouldn’t be reimbursed for your item?
Well, your wish could come true on Jan. 1.
The contracts for the current Medicare DME suppliers, awarded in 2016, will expire on Dec. 31, 2018. But instead of starting another competition, the Medicare agency proposed last week to take a breather from competition in its DME bidding program.
Beginning in 2019, any supplier that’s enrolled in Medicare would be able to supply DME to beneficiaries, rather than just those that were awarded a contract. This would continue until new contracts are awarded, at some undefined point in the future.
During this gap in the competitive bidding program, “there would be no contract suppliers,” the proposal from the Center of Medicare & Medicaid Services said.
The DME bidding program requires competitions among suppliers who operate in particular competitive bidding areas. Suppliers submit a bid for selected products and contracts are awarded to those that offer the best price. Medicare derives the rates for the products from the median of winning bids for an item.
Since 2011, the competitive bidding program has undergone several rounds but Medicare is now proposing a time-out to stand back and take a look at the controversial program.
When the current round of contracts was announced in 2016, Medicare said that the CMS has saved hundreds of millions per year.
But durable medical equipment companies have opposed competitive bidding, which was required by a 2008 law. They’ve argued that the lower rates derived from bidding, as compared to the former fee schedule, have led to beneficiary access problems as suppliers are driven out of business.
“The current program for competitive bidding is broken, so to put it on hold and recognize that we need to fix it is important,” Tom Ryan, president and CEO of the Washington-based American Association for Homecare, told Bloomberg Law.