Medicare News: Durable Medical Equipment, Prosthetics, Orthotics, & Supplies (DMEPOS)

MEDICARE NEWS: DMEPOS Competitive Bidding Program Suspended For 2 Years Starting 1/1/19; But Difficulties In Accessing DMEPOS Will Remain

“DMEPOS,” one of the many important acronyms used in the Medicare program, stands for “Durable Medical Equipment, Prosthetics, Orthotics, & Supplies.”  Medicare covers an extremely broad range of DMEPOS items and supplies — from canes and crutches, to wheelchairs and hospital beds and diabetic testing supplies.

While beneficiaries’ access to DMEPOS has long involved navigating an often-complicated array of procedural and substantive rules; beginning in 2009 the federal Medicare agency rolled out a “Competitive Bidding Program” (CBP), which created a new set of rules affecting accessUnder this program, beneficiaries living in or traveling to specified geographical regions around the country – known as “Competitive Bidding Areas” (CBAs) — had to obtain many types of DMEPOS, as well as mail order diabetic testing supplies, from designated suppliers.

In 2013 broad swaths of Bernalillo, Sandoval, Torrance, and Valencia Counties, along with tiny adjacent pockets of Los Alamos and Santa Fe Counties, were included in an “Albuquerque CBA.”  A crude map of it resembles a proverbial gerrymandered legislative district.

There is no need to further discuss the CBP in this News alert, because, effective January 1st, the program will be suspended nationwide for [at least] two years.*  During that period, and until some variant of the CBA or similar program is established, beneficiaries will be able to obtain DMEPOS items from any willing supplier! [NOTE: this does not apply to Medicare Advantage Plan enrollees, who must use any Plan-restricted suppliers, but MA plans had always been exempt from the CBP]. 

This does not mean that individual beneficiaries who rented or purchased DMEPOS items while the CBP was in effect will necessarily be problem free.  As such beneficiaries know, many types of DMEPOS involve things like rental periods; and ongoing supplier obligations for repairs, maintenance, and, for example, oxygen supplies, that will extend beyond 1/1/19.  The Medicare agency itself has voiced concern that some of these rights and obligations may not be honored by particular suppliers.**

In addition, the suspension of the CBA does not mean that any of the procedural and substantive rules that can impair access to DMEPOS have gone away.  In fact, such procedural and substantive rules are increasing.  For example, at about the same time that the Medicare agency first announced the planned suspension of the CBA, it announced its intention to dramatically increase the number of types of powered wheelchairs, access to which would require prior authorization.  Those requirements were already implemented effective September 1.

* For any reader interested in obtaining further information about how the CBA worked, one good source is CMS Product No. 11461 (Revised June 2017), easily accessible by a “google” search.  In addition, information about DMEPOS generally and the CBP specifically has been available through the Medicare agency’s website (www.medicare.gov), under the home page button for “Find suppliers of medical equipment & supplies;” though it is unclear how long the CBP information will remain there.

** See, for example, CMS Product No. 12031-P (October 2018), easily accessible by a “google” search.  That short publication advises affected beneficiaries to talk promptly with their suppliers to confirm each supplier’s recognition of ongoing obligations.  It also warns of improper marketing efforts; and lists where beneficiaries can submit complaints.

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