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DMEPOS Competitive Bidding Program DMEPOS Competitive Bidding Program

DMEPOS Competitive Bidding Program - PowerPoint Presentation

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DMEPOS Competitive Bidding Program - PPT Presentation

The Durable Medical Equipment Prosthetics Orthotics and Supplies DMEPOS Competitive Bidding Program May 2016 Competitive BiddingA Better Way to Pay Started in January 2011 for certain durable medical equipment prosthetics orthotics and ID: 686753

competitive bidding program supplier bidding competitive supplier program medicare contract 2016 supplies april related equipment accessories dmepos recompete devices

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Slide1

DMEPOS Competitive Bidding Program

The Durable Medical Equipment, Prosthetics, Orthotics, and Supplies (DMEPOS) Competitive Bidding Program

May 2016Slide2

Competitive Bidding—A Better Way to Pay

Started in January 2011 for certain durable medical equipment, prosthetics, orthotics, and supplies (DMEPOS) in 9 areas of the country (Round 1)

In July 2013

The program expanded to more areas (Round 2)

The National Mail-Order Program was implementedLimits fraud and abuse in the Medicare programThe Competitive Bidding Program helps people with MedicareSave moneyGet quality equipment, supplies, and services

April 2016

Competitive Bidding Program

2Slide3

The Competitive Bidding

Program

S

uppliers submitted bids to provide certain DMEPOS

at lower prices than Medicare was payingContracts are awarded to winning suppliers to sell/rent DMEPOS Amount Medicare pays for DMEPOS is based on bidsWhen Medicare pays less, the 20% coinsurance is less

Contract suppliers mustMeet eligibility, quality, and financial standardsBe accredited by an independent organization

April 2016

Competitive Bidding Program

3Slide4

The Competitive

Bidding Program—ContinuedIn most cases, only contract suppliers canProvide competitively bid

DMEPOS

The

types of items Medicare covers doesn't change Contract supplier charge can’t exceed single payment amount based on bids received for an item

Competitive Bidding Program

April 2016

4Slide5

Round 1 Recompete Products1/1/14-12/31/16

Products

Included in

Round

1 Recompete

Respiratory equipment and related supplies and accessories including Oxygen, oxygen equipment and supplies; Continuous Positive Airway Pressure (CPAP) devices and respiratory assist devices (RADs) and related supplies and accessories; and standard nebulizersStandard mobility equipment and related accessories including

Walkers, standard power and manual wheelchairs, scooters, and related accessoriesGeneral home equipment including Hospital beds and related accessories, group 1 and 2 support surfaces, transcutaneous electrical nerve stimulation (TENS) devices, commode chairs,

patient lifts, and seat lifts

Enteral nutrients,

equipment, and supplies

Negative pressure

wound therapy pumps and related supplies and accessories

External infusion pumps and supplies

April 2016

Competitive Bidding Program

5Slide6

Round 1 2017

Required by law to recompete contracts at least once every 3 years

Current Round 1 Recompete contracts and prices expire on December 31, 2016

Contracts and prices for next period to

become effective on January 1, 2017

April 2016

Competitive Bidding Program

6Slide7

Round 2 Competitive Bidding

Contracts and prices Were effective on July 1, 2013

E

xpire June 30, 2016

Program expanded91 Metropolitan Statistical Areas

April 2016

Competitive Bidding Program

7Slide8

Products Included in Round 2*

Products Included in Round 2

Oxygen,

oxygen equipment, and supplies

Enteral nutrients,

equipment, and suppliesContinuous Positive Airway Pressure (CPAP) devices and Respiratory Assist Devices (RADs), and related supplies and accessoriesHospital beds and related accessoriesWalkers and related accessories

Support surfaces (Group 2 mattresses and overlays)Standard (power and manual) wheelchairs, scooters, and related accessoriesNegative pressure wound therapy pumps and related supplies and accessories*Changes from Round 1 to Round 2 in Bold Italics

April 2016

Competitive Bidding Program

8Slide9

National Mail-Order Program for

Diabetes Testing Supplies

Designed to

ensure

that people with Original Medicare continue to get quality supplies and save money People who choose to have diabetes testing supplies delivered to their home need to knowMedicare won't pay unless a national mail-order contract supplier is usedNational mail-order contract suppliers can’t charge more than the deductible and 20% coinsurancePeople can also choose to get supplies from any local store enrolled in Medicare

Local stores can’t charge more than the deductible and 20% coinsurance if they accept assignment

April 2016Competitive Bidding Program

9Slide10

Round 2 Recompete & National

Mail-Order RecompeteRound 2 and National Mail-Order Program

C

ontract periods expires

on June 30, 2016Round 2 Recompete and the national mail-order recompete contracts Become effective on July 1, 2016 Expire on December 31, 2018

April 2016

Competitive Bidding Program

10Slide11

Round 2 Recompete Products7/1/16-12/31/18

Products

Included in

Round

2 Recompete

Enteral nutrients, equipment, and suppliesGeneral home equipment and related supplies and accessories including Hospital beds and related accessories, group 1 and 2 support surfaces, commode chairs, patient lifts, and seat lifts

Nebulizers and related suppliesNegative Pressure Wound Therapy (NPWT) pumps and related supplies and accessoriesRespiratory equipment and related supplies and accessories includingoxygen, oxygen equipment, and supplies, continuous positive airway pressure (CPAP) devices and respiratory assist devices (RADs) and related supplies and accessories Standard mobility equipment and related accessories including

Walkers, standard power and manual wheelchairs, scooters, and related

accessories

Transcutaneous Electrical Nerve Stimulation (TENS) devices and supplies

April 2016

Competitive Bidding Program

11Slide12

The Competitive Bidding

Program— Who will be Affected?

People who have

Original Medicare

andPermanently reside in, or are visiting, a Competitive Bidding Area (CBA) and obtain competitively bid itemsTo find out if a ZIP code is in a CBA or to locate a contract supplier

Visit Medicare.gov/supplier, or Call 1-800-MEDICARE (1-800-633-4227)TTY users call 1-877-486-2048 Medicare Advantage Plans should let their enrollees know if their plan is changing

April 2016

Competitive Bidding Program

12Slide13

Doctors and Other Treating Practitioners Use of Contract Suppliers

Must almost always use contract supplier ifItems and services are included in Competitive Bidding Program where a person with Original Medicare lives

Someone is traveling to or visiting a

c

ompetitive bidding areaDoctors, treating practitioners, and hospitals can supply certain items (e.g.: walkers and folding manual wheelchairs) without being contract suppliersA nursing facility can supply directly to its own residents only if it becomes a contract supplier

April 2016

Competitive Bidding Program

13Slide14

Staying With A Non-Contract Supplier

A consumer can stay with current supplier that doesn’t have a new contract, provided that

Supplier elects to become “grandfathered”

The person with Original Medicare permanently resides in a competitive bidding area

The person with Original Medicare was renting certain equipment or oxygen when the program (or recompeted round) started

April 2016

Competitive Bidding Program

14Slide15

Grandfathering

Non-contract supplier

Must inform Medicare consumers in writing about whether they’ll

continue

renting equipmentWorks with contract supplier to get new equipment if Medicare consumers switch to a contract supplierThe choices areContinue getting services from a grandfathered supplier until rental period ends ORSwitch to a new contract supplier

April 2016

Competitive Bidding Program

15Slide16

Have Other Insurance?

Medicare may make payment to a non-contract supplier if required by primary policyNon-contract supplier must

Be accredited

Have

a valid Medicare billing numberBe eligible to receive secondary payments

April 2015

Competitive Bidding Program

16Slide17

Non-contract Supplier

A non-contract supplier generally may not provide competitively bid items in a competitive bidding area

If a non-contract

supplier

is used and no exception applies, people with Medicare aren’t responsible for payment unless the supplier issues an Advance Beneficiary Notice (ABN)By signing the ABN, the person with Medicare agrees to pay entire amount

April 2016

Competitive Bidding Program

17Slide18

Changing Suppliers Scenario

Obtaining DMEPOS items from a new contract supplier

Mildred’s permanent residence is in Miami, FL, which is a Round 1

C

ompetitive Bidding Area. She’s currently renting her Continuous Positive Airway Pressure (CPAP) device

from ABC Company, which has a Round 1 Recompete contract, but not a Round 1 2017 contract. Mildred receives a notice from ABC Company informing her that they won’t be a contract supplier after December 31, 2016, and that they also won’t be a grandfathered supplier starting January 1, 2017. Mildred must transition to a Round 1 2017 contract supplier for Medicare to help pay.

April 2016

Competitive Bidding Program

18Slide19

Getting DMEPOS When Travelling

To Competitive B

idding

A

reas (CBAs)Must generally use contract supplier for that CBAIf non-contract supplier used and no exception applies, people with Medicare aren’t responsible for payment unless supplier issues Advance Beneficiary NoticeTo non-competitive bidding areasCan use any Medicare-enrolled supplier

April 2016

Competitive Bidding Program

19Slide20

Specific Brands

Doctor must prescribe in writingMedical record must reflect needContract supplier must

Provide the specific brand or form as prescribed OR

Work with the doctor or treating practitioner to find a suitable alternative and obtain a revised prescription OR

Help locate another contract supplier that can Provide the specific brand or form as prescribed

April 2016

Competitive Bidding Program

20Slide21

Equipment Repair & Replacement

For beneficiary-owned medical equipmentAny Medicare-enrolled supplier can make necessary

repairs

For

replacement, must use a contract supplier For warranty repairs, follow the warranty rulesFor rented equipmentRepairs are included in rental payment—the supplier must fix at no charge

April 2016

Competitive Bidding Program

21Slide22

Deductible and Coinsurance

After paying the annual Part B deductible

Medicare pays 80% of the Medicare-approved amount for equipment, supplies, and services

The consumer is responsible for 20% coinsurance

Contract suppliers can’t bill for more than these amountsFor suspected overpayment or fraud, call 1-800-MEDICARE (1-800-633-4227) TTY users call 1-877-486-2048Fraud Hotline of the HHS Office of Inspector General at 1-800-447-8477

April 2016

Competitive Bidding Program

22Slide23

Points to Remember

The Competitive Bidding Program does NOT affect which doctors or hospitals a person with Medicare can use

Generally, a contract supplier must be used for Medicare to help pay

A person with Medicare may

be able to stay with their current supplier if renting from a supplier who has a new contract or elects to become “grandfathered”People in Medicare Advantage Plans should check with the plan

April 2016

Competitive Bidding Program

23Slide24

Resources

Visit Medicare.gov/supplier DMEPOS Supplier Locator Tool

Call

1-800-MEDICARE (1-800-633-4227)

TTY users should call 1-877-486-2048Doctors or suppliersAdministration for Community Living has local information resources

April 2016

Competitive Bidding Program

24