CMS moves forward with bidding, bundling

Wednesday, July 2, 2014

WASHINGTON – CMS on July 2 issued a proposed rule outlining how it plans to expand competitive bidding pricing nationwide and bundle payments for certain DME.

CMS proposes expanding competitive bidding pricing by:

·      Adjusting fee schedule amounts for states in different regions of the country based on competitive bidding pricing from competitions in these regions. The regional prices would be limited by a national ceiling (110% of the average of regional prices) and floor (90% of the average of regional prices).

·      Using the national ceiling as an adjusted fee for states that are predominantly rural or sparsely populated.

·      Adjusting fee schedule amounts for non-contiguous areas based on the average of competitive bidding pricing from these areas or the national ceiling, whichever is higher.

Through a limited phase in, CMS also proposes swapping capped rental policies for bundled monthly payments for enteral nutrition, oxygen, standard manual and power wheelchairs, hospital beds, CPAP devices and respiratory assist devices furnished under competitive bidding. The payment would cover equipment, supplies, accessories and any necessary maintenance and repair.

Other provisions in the rule include:

·      Updating the definition of minimal self-adjustment of orthotics to reflect program guidance on what specialized training is needed to provide custom-fitting services if providers are not certified orthotists.

·      Establishing an exception to the prohibition against subdividing a competitive bidding contract that would allow a contract supplier to sell a distinct company that furnishes a specific product category or a specific competitive bidding area (CBA). Under this exception, CMS would sever the product categories and CBAs that the company services, along with the company’s locations, from the original contract; incorporate those product categories and CBAs and locations into a new contract; and transfer the contract to a new owner under specific circumstances.

CMS will accept comments on the rule until Sept. 2, 2014.

The rule is expected to appear in the July 11 Federal Register.