Page 10 - HME Business, April 2019

News / Trends / Analysis
CMS Releases Initial Round 2021 Details
CMS has released initial details for the next round of its competitive bidding program, which is slated to begin in January 2021, and the program incorporates some significant changes in terms of structural changes, bid areas, schedule and product categories.
Addition of Ventilators
to Bidding a ‘Terrifying
Development’
A public statement from AAHomcare’s Tom Ryan says including non-invasive ventilators in Round 2021 will hurt access for patients that ‘critically depend’ on them.
CMS’sdecision to add non-invasive ventilators to the list of products
covered by its recently announced Round 2021
of competitive bidding “will doubtless be seen
as a terrifying development by patients and care- givers who critically depend on these products,” according to Tom Ryan, president and CEO of the American Association for Homecare.
“Subjecting these highly specialized, service- intensive products to a reimbursement method- ology designed to find the lowest-cost providers will ultimately have the effect of further narrowing the relatively small number of companies that supply ventilators and driving some of the most effective and caring vent providers out of the Medicare program,” Ryan wrote in a public state- ment released on the heels of CMS’s Round 2021 announcement. “Access to these ventilators will become more limited and many current patients will be separated from companies and respiratory professionals who have been with them for years.”
HMEB readers might recall that up until Dec. 17, 2018, CMS was collecting public comments on its plan to include non-invasive ventilators, as well as off-the-shelf back and knee braces in future rounds of competitive bidding. Ryan noted that respiratory providers, patient groups, clinicians and caregivers shared hundreds of comments with the overarching consensus that the plan would hurt vulnerable patients that depend on these items for life support.
Ryan called for those stakeholders to now let lawmakers know their concerns.
“It’s clear that we need to rally the venti-
lator supplier and patient community to signif- icantly raise the volume on this issue with the Administration, on Capitol Hill, and in the media,” he wrote. “Judging from the many suppliers and clinical stakeholders I’ve heard from on this issue since yesterday afternoon, there are a lot of indi- viduals and organizations who will be ready to make sure policymakers understand the impacts of CMS’ action.”
In terms of timing, CMS says it expects the temporary bidding gap that began on Jan. 1 to continue for two years until Dec. 31, 2020. When Round 2021 begins, the program will consolidate both the Round One and Round Two competitive bidding areas (CBAs) into 130 CBAs that will cover the same geographic area as those earlier rounds.
Per a timeline listed on the Competitive Bidding Implementation Contractor (CBIC), the bid window should open this summer. Key agenda items for 2019:
• March 7 — CMS begins pre-bidding supplier
awareness program.
• May — CMS announces dates for registration and
bidding and launches bidder education.
• June — Bidder registration period to obtain user
IDs and passwords begins; the bid window opens.
The bidding program has notably changed the product categories to more narrow groups, but more categories overall. Round 2021 now covers 16 product categories, with newcomers to the program including off-the-shelf (OTS) back braces, OTS knee braces, and non-invasive ventilators. Where OTS back and knee braces are concerned, CMS provides additional detail on the description of these items on its recent statement regarding Round 2021.
The full list:
• Commode chairs.
• Continuous positive airway pressure (CPAP) devices
and respiratory assist devices (RADs).
• Enteral nutrition.
• Hospital beds.
• Nebulizers.
• Negative pressure wound therapy (NPWT) pumps.
• Non-invasive ventilators.
• OTS back braces.
• OTS knee braces.
• Oxygen and oxygen equipment.
• Patient lifts and seat lifts.
• Standard manual wheelchairs.
• Standard power mobility devices.
• Support surfaces (Groups 1 and 2).
• Transcutaneous electrical nerve stimulation
(TENS) devices. • Walkers.
Round 2021 will also include recent structural changes secured through the final ESRD/DMEPOS rule and other legislative and regulatory changes, such as: • The lead item pricing methodology.
• Single payment amounts (SPAs) using maximum
winning bids.
• Bidders must obtain a $50,000 bid surety bond
from an authorized surety bond company.
• Now, when bidders forget to upload a required
financial document, it will receive a zero score for it,
rather than being automatically disqualified. • Each provider location on a bid must meet all
accreditation and state licensing requirements for
every item in the product category.
• Round 2021 will not include a national mail-order
program for diabetes testing supplies.
Lastly, providers whose contract for the Round
Two Recompete, national mail-order Recompete or Round One 2017 was terminated and who were ulti- mately precluded from participating in the next round of bidding aren’t permitted to participate in Round 2021. The Competitive Bidding Implementation Contractor will send a reminder letter to all precluded suppliers before bidding begins for Round 2021.
“Access to these
ventilators will become
more limited and
many current patients
will be separated
from companies and
respiratory professionals
who have been with them
for years,” said Tom Ryan,
president and CEO of the
American Association for Homecare.
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