Impact on Suppliers of Diabetes Products
The Medicare Improvements for Patients and Providers Act of 2008 (MIPPA), which was enacted on July 15, 2008, delayed the implementation of the Durable Medical Equipment, Prosthetics, Orthotics, and Supplies (DMEPOS) Competitive Bidding Program by 18 months. The Program, was scheduled to be implemented in 2007, as mandated by Section 302 of the Medicare Prescription Drug, Improvement, and Modernization Act of 2003 (MMA). MIPPA now delays the implementation of Round 1 until 2009, Round 2 until 2011, and subsequent rounds until after 2011.
In exchange for the delay DMEPOS suppliers had accepted a 9.5 percent reimbursement reduction in 10 product categories that were competitively bid in Round 1. The delay of the Program makes significant changes not only delay the Program, but improve beneficiary access to and increase the Centers for Medicare & Medicaid Services’ (CMS) accountability to beneficiaries and DMEPOS suppliers.
Fortunately and thanks to the hard work by NCPA and other stakeholders, diabetes supplies sold at RETAIL are not subject to the 10.6% cut as they were already excluded from the first round of competitive bidding. Mail order suppliers payments have been reduced as described in MIPPA
Actually, Medicare fees for diabetes testing supplies sold at retail went up January 1. Check out the fee schedule for 2009 along with information on floors and ceilings for all procedure codes and payment categories, jurisdictions, and a short description assigned to each procedure code at www.cms.hhs.gov.
Remember competitive bidding has only been DELAYED through MIPPA and pharmacists supplying diabetes testing supplies or other DMEPOS, according to CMS, MUST make application to an approved accreditation organization on or before January 31, 2009 to assure enough time to complete the facility accreditation process by September 30, 2009.
MIPPA puts mail-order suppliers under the CMS microscope. The legislation permits the Secretary to reject bids for mail-order suppliers of diabetic testing strips that fail to meet the volume threshold established by the Secretary to ensure that winning suppliers are able to adequately furnish beneficiaries with their diabetic supplies. That is, after Round 1 of the Program the Secretary would be permitted to deny contracts to suppliers that are unable to furnish 50 percent of all the various types of diabetic testing strip products. Remarkably, although the legislation currently sets forth a 50 percent threshold, the Secretary is permitted to increase that percentage if the Secretary determines it to be appropriate. In addition, to determine the types of diabetic testing strip products by volume that could be used by the Secretary in deciding whether to reject bid applications, the OIG would be required to conduct a study and submit the results of that study to the Secretary prior to the beginning of any rounds subsequent to Round 1.
Through enactment of MIPPA persons with diabetes will continue to have convenient access to critical supplies through community pharmacies.
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