House makes push for NCB

Monday, June 30, 2003

WASHINGTON - The House of Representatives introduced legislation June 13 that would phase in competitive bidding for durable medical equipment, respiratory meds and medical supplies in 2005 and 2006.

The legislation closely mirrors the House call for competitive bidding last year, but the new bill departs from its predecessor in several notable directions:

- Congress would eliminate inherent reasonableness in areas subject to competitive bidding. But Congress specifically grants CMS the right to use information established during competitive bidding to adjust payments in other areas.

- The legislation would let physicians prescribe a particular brand or item or mode of delivery or service if the item or service involved is clinically more appropriate. “That really ties suppliers hands if they can’t afford, under competitive bidding, to provide it,” said one Washington insider.

- The bill establishes a Program Advisory and Oversight Committee whose members would be appointed by the Secretary of Health and Human Services. The committee would provide technical assistance to CMS as it implements the program.

Like its predecessor in 1997, the House is positioning the measure as a means to combat waste, fraud and abuse in the Medicare program.

Unlike the Senate’s version of Medicare reform, the House bill does not mandate quality standards for HME providers. However, this year’s House package does require the Secretary to establish new quality standards for products subject to competitive bidding by July 1, 2004.

The legislation makes no secret of its targets on the fee schedule. Up first are “the highest cost and highest volume items and services.”

Other interesting provisions:

The Secretary would have the right to waive provisions of the Federal Acquisitions Regulation.

Off-shelf-orthotics would be subject to competitive bidding.

Suppliers will be able to service and replace rented items for patients under their care before the application of competitive bidding. HME