LEEDer Group Inc.
8508 North West 66th St.
Miami, Florida 33166 USA

Phone: 305.436.5030
Fax: 305.436.0086
E-mail Address: info {at] LEEDerGroup [dot] com

2014-11 CMS Updates Competitive Bidding Program





Note: DMEPOS update below; for full artilce see LINK below

  • Defines the methodology for making national price adjustments based upon information gathered from the DMEPOS Competitive Bidding Program: This rule defines methodologies to implement the use of information from the DMEPOS CBP to adjust the fee schedule amounts for DME in areas where competitive bidding programs (CBPs) are not implemented. * The major provisions in this regulation are:
    Adjust fee schedule amounts for items and services based on regional prices limited by a national ceiling (110% of the average of regional prices) and floor (90% of the average of regional prices)
    Adjust 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.

The rule finalizes an expanded policy for rural payment by specifying that the national ceiling will be extended to any area outside an metropolitan statistical area (MSA) designated as a rural area, regardless of whether the state meets the definition of a rural state.

Phase-in of special payment rules in a limited number of areas under the CBP for certain DME: This rule finalizes a limited phase-in of continuous bundled monthly payments for the equipment, supplies, accessories and any necessary maintenance and repairs for standard power wheelchairs and continuous positive airway pressure (CPAP) devices furnished under the CBP in place of capped rental policies. The specific details for phase-in of this special payment rule to competitive bidding areas will be addressed through guidance.

Clarification of the statutory Medicare hearing aid coverage exclusion stipulated at Section 1862(a)(7) of the Act: This rule codifies the Medicare policy guidance when a device is not subject to the hearing aid exclusion. The rule finalizes that certain auditory implants, including cochlear implants, brain stem implants, and osseointegrated implants, do not meet the definition of hearing aids that are excluded from coverage.

Update the definition of minimal self-adjustment of orthotics at 42 CFR ยง414.402: This rule will not finalize an update to the regulation reflecting program guidance on what specialized training is needed to provide custom fitting services if providers are not certified orthotists. Although the regulation is not being updated at this time, the program guidance still stands.

Change of Ownership Rules to Allow Contract Suppliers to Sell Specific Lines of Business: This rule permits bifurcation of a competitive bidding contract under specific circumstances. A competitive bidding contract cannot be sold or subdivided, so the entire competitive bidding contract, including all CBA and product categories must be included in any sale. CMS may permit the transfer of a contract to an entity that merges with or acquires a competitive bidding contract supplier if the new owner assumes all rights, obligations, and liabilities of the competitive bidding contract. This final rule would establish circumstances when we would allow subdividing a contract by allowing a contract supplier to sell a distinct company (e.g., an affiliate, subsidiary, sole proprietor, corporation, or partnership) which furnishes a specific PC or serves a specific CBA. This change to the regulation will apply to all current and future rounds.

Full Article CLICK HERE