BIG CHANGES Coming to Medicare Competitive Bidding Program
CMS has finally published information about the future of Medicare’s Competitive Bidding Program. The current bid contracts in all bid areas will expire December 31, 2018. Up until last week, there had been nothing shared about the future of the program for 2019 and beyond. The proposed rule released July 11th included a ton of information, so we are sharing the highlights for you here:
- CMS Secretary Seema Verma in a press call on July 11 “The current structure doesn’t produce the best prices for patients and doesn’t drive optimal performance by contractors, and it’s simply not sustainable in the long term. In developing today’s rule, we worked with experts to leverage market principles that would support competition when contracts are re-competed under the revised bid program.”
- Bid Program changes will not be ready before January 1, 2019.
- In the interim period beginning January 1, 2019 up until the changes are effective “any Medicare enrolled DME supplier” may provide any items in any area. YES PATIENT CHOICE IS BACK at least temporarily. We are very happy to see this.
- No specific timeline was provided by CMS, so the interim period is unknown. Verma did respond to a question that it may take up to 18 or 24 months for the changes and new contractors to be in place.
- New changes to the program include many recommendations from the DME industry so there is reason to believe the future program structure will allow for more access to local businesses and provide greater patient choice.
- This is a Proposed Rule so nothing is final. Based on CMS rule history, it is highly likely the Final Rule will look exactly like or very, very close to the Proposed Rule. It is expected we will see the Final Rule published in November 2018.
If you would like to read more about these latest developments, you can access the announcement and CMS Fact Sheet.
HME News has also published two very good articles about it http://www.hmenews.com/article/proposed-rule-current-bid-contracts-won-t-be-extended and http://www.hmenews.com/article/cms-s-seema-verma-current-bid-structure-not-sustainable.
Miller's will be monitoring developments very closely and sharing new information as it becomes available.
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.
For the latest news on this issue click here
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.
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.