Are you one of the 21?

Monday, June 28, 2010

BALTIMORE - CMS late last week released a 2011 Proposed Medicare Physician Payment Rule that lists the 21 additional areas to be included in Round 2 of national competitive bidding.

They are, courtesy of Cara Bachenheimer, senior vice president of government relations at Invacare:

Philadelphia-Camden-Wilmington, PA, NJ, DE, MD

Washington-Arlington-Alexandria, DC, VA, MD, WV

Boston-Cambridge-Quincy, MA-NH

Phoenix-Mesa-Scottsdale, AZ

Seattle-Tacoma-Bellevue, WA

St. Louis, MO-IL

Baltimore-Towson, MD

Portland-Vancouver-Beaverton, OR-WA

Providence-New Bedford-Fall River, RI-MA

Buffalo-Niagra Falls, NY

Rochester, NY

Tucson, AZ

Honolulu, HI

Albany-Schenectady-Troy, NY

Worcester, MA

Oxnard-Thousand Oaks-Ventura, CA

Springfield, MA

Bradenton-Sarasota-Venice, FL

Poughkeepsie-Newburgh-Middletown, NY

Stockton, CA

Boise City-Nampa, ID

AAHomecare assembled an unofficial list of the same 21 additional areas back in April.

Other DME-related info in the proposed rule, some of which could be new to providers:

*    Subdivision of large bid areas: CMS proposes subdividing the New York area into five separate bid areas; the Chicago area into four; and the Los Angeles area into two.

*    Elimination of the first-month purchase option: CMS proposes that payment for standard power wheelchairs be 15% of purchase price in months one through three and 6% of purchase price in months four through 13.

*    Mail order diabetic supplies: CMS proposes that mail order be defined as "any item shipped or delivered to the beneficiary's home regardless of the method of delivery"; that bid winners provide, at minimum, 50% of all of the different types of diabetic testing products on the market by brand and model name; and that beneficiaries can't be influenced or incentivized to switch their brands.

*    Payment for oxygen: CMS proposes reconsidering the minimum 10 months of rental payments for oxygen. It also proposes requiring the provider that furnishes oxygen equipment and receives payment for month 18 or later to either furnish the equipment for the remainder of the 36-month rental payment period, or in the case where the beneficiary has relocated, make arrangements for furnishing the oxygen equipment with another provider for the remainder of the rental.

*    Appeals process for terminated contracts: CMS proposes a process for review and reconsideration before a contract is actually terminated.

*    Exemption of off-the-shelf orthotics: CMS would exempt certain off-the-shelf orthotics from the bid program when they are provided by physicians or other practitioners.

According to Bachenheimer: CMS will accept comments on the proposed rule for 60 days after it's published in the Federal Register, probably this week; it will issue a final rule in late October/early November; and it will implement the rule Jan. 1, 2011.

To read Bachenheimer's full summary, go to, Washington Updates.