Government Advocacy

BIG Changes Coming…

Medicare Gap Period January 2019

Medicare’s Competitive Bidding program is in a Temporary Gap Period beginning 1/1/19 and ending 12/31/20. During this period, any “willing” provider may provide bid items in bid territories. The willing provider must accept the bid payment rates for the equipment supplied. Miller’s has reviewed our options and decided that we will be a Willing provider for some specific categories and an Unwilling provider for other categories.


Willing


  • Power Wheelchairs & Accessories
  • Manual Wheelchairs & Accessories
  • CPap & Related Supplies
  • Home Oxygen


Woman in wheelchair in greenhouse
Woman in wheelchair at desk
Couple sleeping with CPAP
Women on street with portable oxygen concentrator

Unwilling


  • Hospital Beds & Related Accessories
  • Walkers & Related Accessories
  • General DME Equipment including bedside commodes, patient lifts, etc.
  • Scooters
  • Nebulizers

The unreasonably low bid rates are often at or below our cost for the items we are unwilling to provide. Medicare has admitted that the low rates have led to access issues for beneficiaries, and that is the primary reason for the Gap period. They are going to restructure the bid process so that the next round is fair to all when it is effective again in 2021. Unfortunately, Medicare did not make any changes to the low payment rates for the gap period. Miller’s will not supply any of the products in the Unwilling section either on an assigned basis or on a non-assigned basis.

We recognize this may cause an inconvenience for some of you, and we will do our very best to minimize that. We will continue servicing any current rental equipment or equipment we have previously provided that is covered under warranty in the Unwilling section. Thank you for your understanding.

It is important to note this notice applies to traditional Medicare primary orders ONLY. Miller’s will STILL supply all of the items above for private insurance plans, Medicaid, Medicaid Managed care plans, Medicare Advantage, and other third-party payers. We have individual contacts with each of those entities.

Miller’s will continue to focus on our core areas of expertise including Complex Rehab Technology, Wheeled Mobility, CPAP, Complex Respiratory Products, & Home Accessibility Solutions.



Young boy in custom wheelchair
Man using stairlift

To learn more about Medicare's Temporary Gap Period or the future of Medicare Competitive Bidding, we suggest you read this article.



Here is a list of local suppliers that are options for those items Miller’s is not supplying:

  • Seeley Medical (330) 733-0996
  • Medical Services (440) 232-3000
  • DASCO (330) 829-0565

If you experience any access issues or want to voice your frustration with Medicare’s bid program/Gap Period, we encourage you to contact:

  • People for Quality Care Hotline 1-800-404-8702
  • 1-800-MEDICARE

If you have any questions for us, please feel free to email Johnny P. Miller or call (330) 753-9600 x12100.

Congress Must Fix Payment Rates for CRT Manual Wheelchair Accessories! YOU CAN HELP!!


Medicare permanently fixed the accessory rates for complex rehab technology power wheelchairs effective July 1, 2017. This was a tremendous win for users of specialized wheelchair systems including people with complex disabilities such as Amyotrophic Lateral Sclerosis (ALS), spinal cord injury, multiple sclerosis (MS) and muscular dystrophy.

However, they did not fix the rates for accessory items for complex rehab technology manual wheelchairs. Medicare continues to use competitive bidding pricing for these items. There is strong support for this manual accessory issue from consumer and clinician groups. This is not just a Medicare issue, their policies affect all other payers including Medicaid and private insurers so this affects users of all ages.

There is legislation in Congress, H.R 3730 and a Senate bill coming out very soon, with strong bipartisan support that will fix this issue specific to manual wheelchair accessories and thereby protect access for the people who rely on this specialized equipment each day. Congress must take action now to fix this.

Click here to email/contact your elected officials – you can make a difference! You will also find additional information about the legislation including Position Paper, Videos, List of Current Sponsors, and much more.

whitehouse


For the latest news on this issue click here

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Medicare Rate Reduction Negatively Impacting Providers and Medicare Beneficiaries

There was another round of Medicare rate cuts effective July 1st 2016 that are negatively impacting DME/CRT providers. This drastic and irresponsible cut applies to all areas of the country not included in Medicare’s competitive bid program. These rate cuts averaged 50-60% compared to 2015 rates and affects all products that are part of the bid program. Products affected include standard power wheelchairs, scooters, standard manual wheelchairs, oxygen, CPap, hospital beds, walkers, nebulizers, patient lifts, bedside commodes, and many others.

It is unrealistic for providers to simply absorb these cuts and continue business as usual. Some providers around the country have closed their doors while others have stopped doing business with Medicare. Read more about the provider impact here. The article here shares the story of an Illinois provider that once served President Abraham Lincoln and is now closing their doors after 170 years- very sad to see.

Miller’s is doing everything we can to continue providing service for our clients and referrals. It is important we do so in a way that makes sense with the new rates. Effective August 1, 2016 Miller’s no longer accepts Medicare assignment for ambulatory aids including walkers and quad canes. The new rates do not even come close to covering our costs to provide.

Medicare beneficiaries can still obtain a walker from Miller's, and they can do so on a non-assigned basis. Non-assigned means the client pays Miller’s in full our retail charge for the walker. We can then submit a non-assigned claim to Medicare if the client requests it. If a non-assigned claim is submitted and Medicare determines the walker is medically necessary, Medicare would pay the client directly the Medicare fee schedule amount. Note this payment amount is approximately 40% of the amount the client paid to Miller’s to originally purchase the walker. There is no guarantee the client will receive any reimbursement from Medicare.

The client does have the choice to seek a different DME provider that may still accept Medicare assignment for walkers. Miller’s will continue to provide ambulatory aids assigned to other payers. This is subject to change depending on their ambulatory aid rates.

Rollator

It is unfortunate it has come to this. Miller’s and the DME industry has worked tirelessly to educate CMS and elected officials that at some point we could not provide after so many rate cuts. If you would like to voice your concern about these rate cuts, please visit the American Association for Homecare's Action Center here and let your legislators know.

Medicare Competitive Bid Round 2 News Here