Page 10 - HME Business, March 2017

News / Trends / Analysis
CMS Announces, Then Delays Competitive Bidding Round 2019
A week after announcing major bid program overhaul, CMS puts the plan back under wraps.
In a surprise, “now you see it, now you don’t” move, the Centers for Medicare and Medicaid Services announced and then delayed competitive bidding Round 2019.
CMS even went so far as to put all Round
2019 documentation under wraps. This included removing all the information it posted to its
site on Jan. 31, and instructing the Competitive Bidding Implementation Contractor (CBIC) to remove the information from its website, as well.
Under the original announcement, the Round 2019 plan would have consolidated all rounds and bid areas for the bidding program into a single round of competition. In terms of a time- line, CMS had reported that after Round One 2017, the Round Two Re-compete, and the national mail-order competition conclude on Dec. 31, 2018, the Round 2019 contracts would become effective Jan. 1, 2019, and would run until Dec. 31, 2021.
Additional changes to the program included:
• Lead item bidding for a primary item within a
group of related equipment. The single payment amount for the items within the group would be based on the lead item.
• A $50,000 surety bond requirement for each CBA in which a bidder submits a bid.
• Ten CBAs were designated for the CPAP devices and related accessories product category only,
with five of those new CBAs, requiring payment for the CPAP device, related accessories, and services to be made on a bundled, non-capped monthly rental basis.
• Per CMS’s previous announcement, Round 2019 would have included 141 competitive bidding areas, and would have covered 11 product categories. Updates to the categories include the addition of insulin pumps and supplies as a product category to be bid in the national CBA. A statement from the American Association for
Homecare said that the organization applauded “the common-sense decision to carefully examine the bidding program before moving forward with new rounds.”
“We expect the delay will give CMS an opportunity to make a careful assessment of a bidding program that is clearly in need of exten- sive fixes,” the AAHomecare statement read. “AAHomecare will work to make sure that the industry’s concerns about the bidding program — an initiative that is putting long-time HME companies out of business, reducing beneficiary access, and resulting in reimbursement rates below provider costs — are effectively presented to CMS.”
CMS advised DMEPOS suppliers to watch the CMS.gov and dmecompetitivebid.com for updates. n
— David Kopf, dkopf@1105media.com
CMS Instructs DME MACs on CURES Reimbursement
CMS outlines how DME MAC contractors are to begin implementing retroactive reimbursement per the law.
CMS has released guidance instructing the DME MACs on how they should process the retro- active reimbursement for claims impacted by bid expansion, as mandated by the 2016 CURES Act. However, providers might want to be patient as reimbursement is not expected until at least May.
The Act, which became law last December, includes provisions that required CMS to provide retroactive relief to non-bid providers impacted
by the 2016 national expansion of competi-
tive bidding. The Act required CMS to extend
the initial phase of partial reimbursement cuts to impacted items from ending on June 30, 2016 to ending on Dec. 31, 2016. The full cuts, which had started on July 1, 2016, were then pushed to Jan. 1, 2017. CMS was instructed to retroactively reim- burse claims filed between July 1, 2016 and Dec. 31, 2016 for the difference between the partial reimbursement cut and the full reimbursement cut.
Under CMS’s guidance, which the agency released at http://bit.ly/2loPPZ8, CMS says it will provide a revised fee schedule to the DME MACs on or after May 1, 2017. The DME MAC contrac- tors must then reprocess the affected claims and to begin a “one time claims adjustment process” to reimburse the claims. CMS officially set the
implementation date for the guidance at July
3, but instructed the DME MAC contractors to reprocess claims as soon as they had the revised fee schedule.
The guidance noted that CMS will provide an in-depth “provider education article” at the MLN Matters Articles site that DME MACs will then need to repost in order to educate providers.
“While this interim relief is welcome news for rural and non-bid area providers, AAHomecare remains committed to advocating for a longer- term solution to deliver sustainable reimbursement rates for rural and non-bid area providers,” the American Association for Homecare noted
in a statement released after CMS distributed the guidance. n
— David Kopf, dkopf@1105media.com
WEBINARS
More industry intelligence is available at hme-business.com.
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