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

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 implemented  Limits fraud and abuse in the Medicare program  The Competitive Bidding Program helps people with Medicare Save money Get quality equipment, supplies, and services October 2015Competitive Bidding Program2

The Competitive Bidding Program  Suppliers submitted bids to provide certain DMEPOS at lower prices than Medicare was paying  Contracts are awarded to winning suppliers to sell/rent DMEPOS  Amount Medicare pays for DMEPOS is based on bids When Medicare pays less, the 20% coinsurance is less  Contract suppliers must Meet eligibility, quality, and financial standards Be accredited by an independent organization October 2015Competitive Bidding Program3

The Competitive Bidding Program—Continued  In most cases, only contract suppliers can Provide 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 October 2015Competitive Bidding Program4

Round 1 Recompete Products 1/1/14-12/31/16 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 nebulizers Standard mobility equipment and related accessories including  Walkers, standard power and manual wheelchairs, scooters, and related accessories General 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 October 2015Competitive Bidding Program5

Round 1 Recompete—2017  The law requires contracts to recompete at least once every 3 years  Current period expires on December 31, 2016  Contracts for next period to become effective on January 1, 2017 October 2015Competitive Bidding Program6

Round 2 Competitive Bidding  Contract and prices Were effective on July 1, 2013 Expire June 30, 2016  Program will expand 91 Metropolitan Statistical Areas October 2015Competitive Bidding Program7

Products Included in Round 2* Products Included in Round 2 Oxygen, oxygen equipment, and supplies Enteral nutrients, equipment, and supplies Continuous Positive Airway Pressure (CPAP) devices and Respiratory Assist Devices (RADs), and related supplies and accessories Hospital beds and related accessories Walkers and related accessories Support surfaces (Group 2 mattresses and overlays) Standard (power and manual) wheelchairs, scooters, and related accessories Negative pressure wound therapy pumps and related supplies and accessories * Changes from Round 1 to Round 2 in Bold Italics October 2015Competitive Bidding Program8

National Mail-Order Program for Diabetic Testing Supplies  Designed to ensure that people with Original Medicare continue to get quality supplies and save money People who choose to have diabetic testing supplies delivered to their home need to know  Medicare won't pay unless a national mail-order contract supplier is used  National mail-order contract suppliers can’t charge more than the deductible and 20% coinsurance People can also choose to get supplies from any local store  Local stores can’t charge more than the deductible and 20% coinsurance if they accept assignment October 2015Competitive Bidding Program9

The Competitive Bidding Program— Who will be Affected?  People who have Original Medicare and Permanently reside in, or are visiting, a Competitive Bidding Area (CBA) and obtain competitively bid items  To find out if a ZIP code is in a CBA or to locate a contract supplier Visit Medicare.gov/supplier, orMedicare.gov/supplier Call MEDICARE ( )  TTY users call  Medicare Advantage Plans should let their enrollees know if their plan is changing October 2015Competitive Bidding Program10

Round 2 Recompete & National Mail-Order Recompete  Round 2 and National Mail-Order Program Contract periods expire on June 30, 2016  Round 2 Recompete and the national mail- order Recompete contracts Become effective on July 1, 2016 Expire on December 31, 2018 October 2015Competitive Bidding Program11

Doctors and Other Treating Practitioners Use of Contract Suppliers  Must almost always use contract supplier if Items and services are included in Competitive Bidding Program where a person with Original Medicare lives Someone is traveling to or visiting a competitive bidding area  Doctors, treating practitioners, and hospitals can supply certain items (e.g.: walkers and folding manual wheelchairs) without being contract suppliers  A nursing facility can supply directly to its own residents only if it becomes a contract supplier October 2015Competitive Bidding Program12

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 (CBA) The person with Original Medicare was renting certain equipment or oxygen when the program (or recompeted round) started October 2015Competitive Bidding Program13

Grandfathering  Non-contract supplier Must inform Medicare consumers in writing about whether they’ll continue renting equipment Works with contract supplier to get new equipment if Medicare consumers switch to a contract supplier  The choices are Continue getting services from a grandfathered supplier until rental period ends OR Switch to a new contract supplier October 2015Competitive Bidding Program14

Have Other Insurance?  Medicare may make payment to a non- contract supplier if required by primary policy  Non-contract supplier must Be accredited Have a valid Medicare billing number Be eligible to receive secondary payments October 2015Competitive Bidding Program15

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 October 2015Competitive Bidding Program16

Changing Suppliers Scenario Obtaining DMEPOS items from a new contract supplier Mildred’s permanent residence is in Miami, FL, which is a Round 1 Competitive Bidding Area. She’s currently renting her Continuous Positive Airway Pressure (CPAP) device from ABC Company, which has a 2016 Round 1 Recompete contract, but not a 2017 Round 1 Recompete 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, Mildred must transition to a Round 1 Recompete contract supplier for Medicare to help pay. October 2015Competitive Bidding Program17

Getting DMEPOS When Travelling  To Competitive Bidding Areas (CBAs) Must generally use contract supplier for that CBA If non-contract supplier used and no exception applies, people with Medicare aren’t responsible for payment unless supplier issues Advance Beneficiary Notice  To non-competitive bidding areas Can use any Medicare-enrolled supplier October 2015Competitive Bidding Program18

Specific Brands  Doctor must prescribe in writing  Medical record must reflect need  Contract 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 October 2015Competitive Bidding Program19

Equipment Repair & Replacement  For owned medical equipment Any Medicare-enrolled supplier can make necessary repairs For replacement, must use a contract supplier For warranty repairs, follow the warranty rules  For rented equipment Repairs are included in rental payment—the supplier must fix at no charge October 2015Competitive Bidding Program20

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 amounts  For suspected overpayment or fraud, call MEDICARE ( )  TTY users call Fraud Hotline of the HHS Office of Inspector General at October 2015Competitive Bidding Program21

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 October 2015Competitive Bidding Program22

Resources  Visit Medicare.gov/supplierdirectory/search.htmlMedicare.gov/supplierdirectory/search.html DMEPOS Supplier Locator Tool  Visit Medicare.gov/supplierMedicare.gov/supplier Consumer information  Call MEDICARE ( ) TTY users should call  Doctors or suppliers  Medicare’s local information resources State Health Insurance Assistance Programs Administration for Community Living October 2015Competitive Bidding Program23

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