statement yesterday announcing the delay of the national competitive bidding
program. The statement came one day after both the U.S. House of Representatives
and Senate overrode President Bush’s veto of H. R.6331, which will reform and
postpone the competitive bidding program.
while the Senate voted 70 to 26 to pass the law, which will delay the national competitive
bidding program by 18 to 24 months.
according to Cara Bachenhemier, senior vice president of government relations
at Invacare Corp.
to redo the program based on the mandates that Congress put in the legislative
language,” she says. “It’s going
to require them to go back to the drawing board and rewrite the competitive
bidding regulation in its entirety. That’s about a two-year process – they’re
probably going to try to speed it up – and redo the bid process based on that.
They literally are going back to square one to recraft the program.”
beneficiaries may now use any Medicare-approved supplier for durable medical
equipment. Beneficiaries who changed suppliers at the start of the program can
continue to use the new supplier or choose another.
doesn’t fall apart, Bachenhemier explained.
“If the beneficiary chooses to continue with that supplier,
that’s their decision,” she says. “The pricing will change; the law
is retroactive to June 30. So what that means is bid pricing will not be in
effect. Providers will be paid at the prices that were in effect June 30 and
are again in effect. Since the law is retroactive, it’s as if those bid prices
were never in effect.”
CMS sent e-mail communication to winning providers informing the winners that the contracts signed in the competitive bidding program for the nine product
categories in those 10 areas are null and void, says Seth Johnson, vice
president of government affairs for Pride Mobility Products. Providers, who are
now back to operating as they were during June, will be paid at the Medicare
fee schedule amounts for any of those items that were to be included in competitive
bidding.
The fee schedules are going to get adjusted for 2009, says David
McCausland, senior vice president of planning and government affairs of
The ROHO Group.
“So the fees are going to get cut as of the fiscal year,” he says.
CMS plans to notify beneficiaries in the 10 competitive
bidding areas about the change through a letter within two weeks. The first
round of competitive bidding began in the following areas: Charlotte-Gastonia-Concord, N.C.-S.C.;
Cincinnati-Middletown, Ohio-Ky-Ind; Cleveland-Elyria-Mentor, Ohio; Dallas-Fort Worth-Arlington, Texas; Kansas City, Mo-Kan; Miami-Fort Lauderdale-Miami Beach, Fla.;
Orlando-Kissimmee, Fla.; Pittsburgh, Pa.; Riverside-San Bernardino-Ontario,
Cali; and San Juan, PR.
Those suppliers who won bids in the areas listed above are
not obligated to fulfill contractual duties. It’s more of an ethical than legal
issue, Bachenheimer says.
“You certainly don’t want to leave a beneficiary
stranded, particularly if you’re midstream in the process,” she says.
“Though in today’s world, you can’t get very far in 14 days.”
With the exception of
oxygen and power wheelchairs, the HME industry will pay for the delay through
9.5 percent price cuts to DME.
Bachenhemier believes that removing complex rehab from the
bidding program is a step in the right direction.
“It was the most inappropriate package of services for
a bidding program,” she says.” It (now) will never be in a bid
program, unless Congress changes the law. It’s a permanent exclusion that helps
the whole category of products and services.”
Johnson says he’s concerned about the application of the
9.5 percent cut to power wheelchair providers, especially in the light of the
significant reductions that took place in November of 2006. “Clearly,
providers of complex rehab products and services do not have another 9.5 or
really 10 percent to give,” Johnson says. “We need to do everything
we can to provide for a parallel exemption for that cut to complex rehab. We do
believe that was the intention of Congress to do that. They recognize the need
to provide an exemption for complex rehab, so there’s no reason complex rehab
should pay for or have to incur that 9.5 percent reduction in payments January
1 of next year.”
Johnson says there is language in the legislation that would
exempt seating and positioning and other accessories that are not provided on
the power wheelchairs included in competitive bidding from the cut.
So there’s going to be the establishment of modifiers to the extent you’re
using some kind of seating product on a manual wheelchair or using power
elevating (legrests) or some other type of related accessory on a
non-competitive-bid item, the reimbursement level for those related accessories
would be exempt from that 9.5 percent cut. That was an important distinction
and clarification in the legislation, Johnson added.
McCausland explained that some items were “sort of” included in the bidding, such as wheelchair seating and accessories. These items were included as accessories when associated with a power wheelchair, but they weren’t included when they were with a manual wheelchair.
“But the legislation had nothing to support that,” he says. McCausland says it was their full intention that Group 2 support surfaces were going to take that 9.5 percent cut. For wheelchair seating and accessories, 20 to 25 percent of business is associated with power wheelchairs, he says. But the vast majority was associated with manual wheelchairs.
“So we raised the issue loud and long to say this just isn’t fair,” he says. “And thankfully we got the right people to recognize that.”
“Now as the dust starts to settle and we’ve got a few months,” he says, “we’ve got to make sure that CMS doesn’t decide it wants to go off with a totally different interpretation.”
CMS says it plans to
implement other provisions of the legislation in the coming months and will
announce additional information as it becomes available.
