On October 28, CMS issued final rule CMS-1651-F. Although the title reflects the primary purpose to alter the End Stage Renal Disease Prospective Payment System, the document also contains critical updates to the DMEPOS Competitive Bidding Program. The final rule makes significant changes to the competitive bidding process. In the next round of competitions (for 2019 contracts):
- Bidders must obtain a bid surety bond in the amount of $50,000 for each competitive bidding area where they submit a bid. The bonds will serve as a condition of forfeiture for contracts that are not accepted where the rates are at or above the bid amount.
- A new appeal process will be available to suppliers in the event that CMS takes any breach of contract action, and CMS will now issue a notice of a breach of contract rather than a notice of contract termination.
- Bid limits will be set using the unadjusted 2015 fee schedule and will not be based on fee schedules that are subject to continuous adjustment derived from contract pricing.
- Certain groups of similar items (like walkers, beds, TENS, support surfaces and powered mobility) will have bid limits that will be governed by a lead item. The bid limit will be determined first by ranking 2012 utilization statistics for the group to determine weight, second by multiplying the weight by 2015 non-adjusted pricing for those items, and finally by taking the average of those “weighted rates” to set lead pricing. This methodology is required to ensure that products with the most features and utilization receive the highest reimbursement and lesser items with fewer features do not exceed the “lead pricing."
The final rule was issued after months of anticipation and was posted online Nov. 4. 338 comments were submitted to CMS on the proposed rule, but only a few were related to the DME provisions. We will be covering additional nuances of these changes in our next edition of our Vista Notes Live! webinar in December for our dedicated subscribers.
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