On October 27, 2020, the Centers for Medicare and Medicaid Services (CMS) announced the Single Payment Amounts (SPAs) for select Off-the-Shelf (OTS) knee and OTS spinal orthosis codes included in the Medicare DMEPOS competitive bidding program scheduled for implementation on January 1, 2021.
AOPA has continually expressed a need for CMS to delay implementation of Round 2021of the Medicare DMEPOS competitive bidding program due to the COVID-19 Public Health Emergency (PHE). These efforts include but are not limited to multiple communications with high ranking CMS officials, coordination of advocacy efforts with AOPA partner organizations both within and outside of O&P, vocal support of congressional efforts, including a letter to CMS signed by more than 100 members of Congress requesting consideration of a program delay, and comprehensive discussions with key legislators on the importance of ensuring Medicare beneficiaries have access to high quality, clinically appropriate care, delivered by properly credentialed and accredited providers.
AOPA will continue to provide feedback to CMS through these and other channels. In addition, AOPA is still working to secure co-sponsors and congressional support for the Medicare O&P Patient Centered Care Act which includes a provision that, if enacted, would preserve patient access to OTS orthoses from certified and/or licensed orthotists and prosthetists by creating an exemption from the requirement to have a competitive bidding contract, similarly to physicians and other healthcare professionals. To support this legislative effort visit AOPAvotes.org.
While CMS removed several product categories from inclusion in Round 2021, it elected to move forward with competitive bidding for OTS knee and OTS spinal orthoses. The product categories removed from inclusion in competitive bidding by CMS represented product categories that have been part of the Medicare DMEPOS competitive bidding program in the past. Due to their inclusion in previous rounds of competitive bidding, SPAs were established nationally that resulted in significant savings to the Medicare program. New bids that were submitted as part of the Round 2021 competition for these product categories did not result in significant additional savings for the Medicare program. Because OTS knee and OTS spinal orthoses were not previously part of Medicare competitive bidding, the competition resulted in significant savings to the Medicare program over the three-year initial program length and the subsequent expansion of the SPAs into non-competitive bid areas.
In its announcement, CMS indicated that in a limited number of CBAs where competitive bidding did not result in significant savings to the Medicare program and therefore, competitive bidding for OTS orthoses will not be implemented. AOPA will be providing more information about these CBAs shortly.
If you elected to participate in the competitive bidding program for OTS knee orthoses, OTS spinal orthoses, or both, you will either be offered a contract effective for claims with a date of service on or after January 1, 2021 or you will receive a disqualification notice indicating that you will not be offered a contract. If you are offered a contract, you must accept or decline the contract offer by November 10, 2020. It is important to remember that if your previously submitted bid was found to be at or below the median composite bid rate and you decline a contract offer, you will forfeit your $50,000 bid surety bond. Your contract offer(s) will indicate whether your submitted bid was at or below the median composite bid rate. If you receive a disqualification notice and believe that you were disqualified incorrectly, you may submit a bidder inquiry through the DMEPOS competitive bidding website portal.
The SPAs for each competitive bidding area (CBAs) and detailed information regarding next steps may be found on the Medicare DMEPOS competitive bidding website here. The complete CMS announcement may be viewed here.