CMS Announces MSAs, Product Categories
for DMEPOS Competitive Bidding

By William Popomaronis, R.Ph.

The Centers for Medicare & Medicaid Services (CMS) has issued its final rule governing Medicare payments for certain durable medical equipment, prosthetics, orthotics, and supplies (DMEPOS) through its competitive bidding program. Information on the final rule is available at:
http://www.cms.hhs.gov/CompetitiveAcqforDMEPOS/
02_regsnotices.asp.

Metropolitan Statistical Areas for First Round of
Competitive Bidding:

Initially, the competitive bidding program will be launched in 2007 in the following 10 Metropolitan Statistical Areas (MSAs):

  • Charlotte-Gastonia-Concord, NC-SC
  • Cincinnati-Middletown, OH-KY-IN
  • Cleveland-Elyria-Mentor, OH
  • Dallas-Fort Worth-Arlington, TX
  • Kansas City, MO-KS
  • Miami-Fort Lauderdale-Miami Beach, FL
  • Orlando, FL
  • Pittsburgh, PA
  • Riverside-San Bernardino-Ontario, CA
  • San Juan-Caguas-Guaynabo, PR

The program will be expanded into 70 additional MSAs in 2009 and into additional areas after 2009. With full implementation set for 2010.

Areas that may be exempt from DMEPOS competitive bidding include rural areas and areas with low population density within urban areas that are not competitive, unless there is a significant national market through mail order for a particular item or service. Since the statute does not allow CMS to exempt areas where there is a national mail order market, the competitive bidding areas (CBAs) for the mail-order diabetic supply category will be the same as the boundaries for the 10 MSAs. A listing of the zip codes included in each CBA will be available in the near future.

Affected Product Categories

At the outset, the competitive bidding program will include 10 of the top DMEPOS product categories.

  1. Oxygen Supplies and Equipment
  2. Standard Power Wheelchairs, Scooters, and Related Accessories
  3. Complex Rehabilitative Power Wheelchairs and Related Accessories
  4. Mail-Order Diabetic Supplies
  5. Enteral Nutrients, Equipment, and Supplies
  6. Continuous Positive Airway Pressure (CPAP) Devices, Respiratory Assist Devices (RADs), and Related Supplies and Accessories
  7. Hospital Beds and Related Accessories
  8. Negative Pressure Wound Therapy (NPWT) Pumps and Related Supplies and Accessories
  9. Walkers and Related Accessories
  10. (Miami and San Juan Only) - Support Surfaces (group 2 and 3 mattresses and overlays)

A listing of the items contained in each product category will be available in the near future.

Timeline:

The bidding process will begin later this month, with CMS accepting bids for 60 days. Winning bids will be announced in December. CMS will use the median of the winning bids to establish "Medicare single payments," which will apply universally to like products within each CBA. The Medicare single payments will replace current fee schedule amounts for those products, and will go into effect in April 2008.

DMEPOS suppliers will have to be accredited in order to win Medicare bids, although bids may be submitted by those with pending accreditation. For more information on accreditation, visit NCPA's DME Resource Center.

Small Suppliers:

Small businesses will garner protection from CMS's "30 percent rule." The rule ensures that at least 30 percent of bid winners are small businesses. Those too small to supply equipment to an entire CBA alone will be allowed to unite with other small suppliers to submit bids.

For the latest information on DMEPOS Competitive Bidding, visit NCPA's DME Resource Center, and register for DMe-Alerts.

  
 
 

William Popomaronis, R.Ph., is vice president, long term and home health care services for the National Community Pharmacists Association (NCPA). He is also the only pharmacist member of Medicare’s Program Advisory and Oversight Committee (PAOC), which provides advice on the development and implementation of the DME Competitive Acquisition Program.

  
 
  Bayer HealthCare, Diabetes Care, has underwritten the costs of this communication. The information expressed in this communication are the views of NCPA. Bayer is not responsible for the accuracy of the information expressed in this communication. Any questions related to DME Accreditation and/or Competitive Bidding for DMEPOS should be directed to the Centers for Medicare and Medicaid Services or NCPA.