On July 11, 2018, the Centers for Medicare and Medicaid Services (CMS) released a proposed rule that proposes several changes to the Medicare Durable Medical Equipment, Prosthetics, Orthotics, and Supplies (DMEPOS) competitive bidding program. In addition to the proposed changes to the competitive bidding program, the proposed rule also solicits comments regarding ways to improve the gap filling methodology that is used to establish Medicare fee schedule amounts for new items and technologies.
Two items of note in the proposed rule include the fact that off the shelf (OTS) orthoses are not mentioned as a potential product category for any envisioned revisions to the competitive bidding program, and that the current DMEPOS competitive bidding program will be effectively suspended when existing contracts expire at the end of 2018 and will remain suspended until such time as any new contracts are awarded under the rules that are being proposed by CMS. While OTS orthoses are eligible for inclusion in competitive bidding under the law that created the program, CMS has, to date, not made, or announced any decision to include them as a product category in the competitive bidding program. The announcement that the competitive bidding program will effectively be suspended when current contracts expire in 2018 is a significant development in that it acknowledges the negative impact that competitive bidding has had on patient access to medically necessary DMEPOS services, especially in rural areas. While the competitive bidding program has not directly impacted the delivery of O&P care to date, we are hopeful that CMS’ commitment to improving the program will help ensure that access to O&P care for Medicare beneficiaries remains available if the time comes when OTS orthoses might be included in competitive bidding in the future.
AOPA is currently reviewing the 368 page document and will prepare a full analysis for its members in the near future.
The CMS Fact Sheet regarding the proposed rule may be viewed by clicking here.
The complete proposed rule may be viewed by clicking here.