Industry stakeholders seek changes to bid framework, enrollment moratorium

WASHINGTON – Industry stakeholders hit Capitol Hill the week of March 9 for a series of high‑level meetings aimed at convincing the Centers for Medicare & Medicaid Services (CMS) to remove the remote‑item delivery (RID) framework from the next round of competitive bidding. They argue the agency has the authority to do so under its existing sub‑regulatory powers.

Stakeholders say CMS is using RID – which would require nationwide fulfillment capabilities – to shrink the pool of participating providers from hundreds to as few as eight to 10. They say such a shift would harm both HME businesses and the patients who rely on their products.

“It’s really an outrage,” said Tom Ryan, president and CEO of AAHomecare. “It’s health care consolidation at its worse, and it’s misaligned with the broader message from the administration. If they need to move forward with competitive bidding – and we’re also working to delay it, legislatively – you could very easily make this optically better for all by dropping RID.”

During the week, stakeholders – joined by lobbyists with strong administration ties – met with senior officials at the White House, the Small Business Administration (SBA) and CMS.

RID’s impact on competitive bidding

This new round of the competitive bidding includes a RID framework for all included product categories, including continuous glucose monitors (CGMs), urological and ostomy supplies, and hydrophilic urinary catheters. Previous rounds of the program have not required nationwide fulfillment capabilities, with the exception of the national mail-order program for diabetes testing supplies.

Stakeholders point out that CMS has already modified the structure of this round by removing tracheostomy supplies.

“We’re going to chip away at all of it,” Ryan said. “We have two years to get this done.”

Legislative work to delay competitive bidding

While pursuing regulatory changes, stakeholders are simultaneously laying groundwork in Congress for a broader delay to the competitive bidding program. They were recently successful in including a five-year delay for CGMs and insulin pumps in a larger, diabetes‑focused legislative package. Jay Witter, senior vice president of public policy for AAHomecare, had previously met with staff for Sens. Susan Collins, R‑Maine, and Jeanne Shaheen, D‑N.H., the bill’s sponsors and co-chairs of the Senate Diabetes Caucus, to outline industry concerns.

“I was prepared to give talking points about the need for a delay and their staff said them right to me first,” he said. “I realized very quickly we were on the same page.”

Stakeholders are also shaping a similar competitive bidding delay bill for CGMs and insulin pumps in the House of Representatives, along with separate legislation addressing ostomy and urological supplies in both chambers.

Concerns over Medicare enrollment moratorium

Meetings also touched on CMS’s six‑month moratorium on new Medicare enrollments for DMEPOS suppliers. Though stakeholders support efforts to curb fraud, waste and abuse, they warn the moratorium could hinder providers seeking to expand through new locations or mergers and acquisitions, especially in the ramp up to the next round of bidding.

Their request: a waiver for providers with at least 36 months in business, similar to one used during a previous home health moratorium.

“We’ve talked to our members (of all sizes) and they’re very concerned about suppliers that have been in business for a long time getting caught up in this same net,” Ryan said.

To support compliance efforts in the wake of the moratorium, VGM Government Relations has also refreshed and relaunched its Fraud, Waste & Abuse (FWA) Reporting Resource Center. The online tool offers direct links to each state’s fraud reporting system, along with CMS’s reporting resources and guidance.