CMS confirms limited scope for next round of competitive bidding 

WASHINGTON – The Centers for Medicare & Medicaid Services (CMS) has confirmed that the product categories for the next round of the competitive bidding program (CBP) will be limited to those included in the remote item delivery (RID) CBP.  

While this is good news for providers of legacy product categories like CPAP devices and oxygen concentrators in the short term, industry experts caution that CMS’s decision may not be permanent.  

“The important thing for suppliers to know is, it’s not now but it’s not never,” said Andrea Stark, a Medicare consultant and reimbursement specialist for MiraVista.  

What’s included in the next round of the CBP 

In a rule published Nov. 28, CMS finalized the RID CBP for the following product categories:  

• Class II Continuous Glucose Monitors (CGMs) and insulin pumps   
• Urological supplies   
• Ostomy supplies   
• Hydrophilic urinary catheters   
• Off-the-shelf (OTS) back braces   
• OTS knee braces   
• OTS upper extremity braces  

Home medical equipment (HME) stakeholders sought clarification from CMS that product categories included in previous rounds of CBP would not be added at a later date. They speculated whether or not the agency would include additional product categories when it announces the lead items in late spring / early summer.  

AAHomecare and VGM & Associates reported late on Tuesday afternoon that CMS had subtly tweaked its Fact Sheet to make it clearer that the next round of CBP will be limited to the RID CBP product categories. The agency changed the headline above the included product categories from “Remote Item Delivery (RID) DMEPOS CBP Product Categories” to the “DMEPOS CBP Product Categories” and added a note that "All product categories for the next round will be included in the Nationwide Remote Item Delivery Program.” 

Industry perspective 

Experts advise providers who supply product categories that have not been included in the RID CBP to stay up to speed with the program and use what could be a temporary pause in their participation to work on operational and cost efficiencies.  

“With this final rule, CMS has cleared all of the hurdles to reactivate a CPAP bid at the snap of a finger,” Stark said. “It will go through a similar process – they'll have 18 to 24 months to prepare – but CMS is under no compulsion to wait until the end of the current RID CBP. We had Round 1 and Round 2 going at the same time.”  

Stakeholders have argued that price discovery has already been achieved for the product categories that were included in the last round of competitive bidding but weren’t implemented due to insufficient cost savings. However, they caution against interpreting CMS’s decision to exclude these categories from the next round as agreement.  

“I wouldn’t say they think they have price discovery and they’re good to go,” said Kim Brummett, senior vice president of regulatory affairs for AAHomecare. “It’s important to note that because of the way they designed the next round with the bid ceiling, the current single payment amount plus 10% and the 75th percentile instead of the clearing price.”

Other industry reaction

“This is a significant win for a large segment of the home medical equipment community and the patients they serve,” said Tom Ryan, AAHomecare president & CEO. “It’s a great result following the wave of comments and our industry’s comprehensive advocacy effort responding to a flawed framework for restarting the bidding program. Even with this win in hand on many product categories, there is still work to be done. AAHomecare plans to continue efforts to delay the next bidding round or improve its framework on behalf of diabetes, ostomy, and urological product stakeholders who will be subject to bidding. I know that companies who provide these products and patient advocates are still committed to that fight – and AAHomecare is going to fight alongside them.”   

“The upcoming round of competitive bidding presents significant challenges for patients and providers alike," said Ike Isaacson, senior vice president of government and regulatory relations for The VGM Group. "At VGM, we remain steadfast in defending patients’ rights to choose their health care provider and to maintain access to trusted, local services. This recent clarification from CMS enables us to sharpen our message to legislators and industry stakeholders, underscoring the harmful consequences this bidding rule imposes on both patient care and the viability of community-based businesses.”