WASHINGTON, D.C. (October 27, 2020)—Today, the Centers for Medicare & Medicaid Services (CMS) announced the single payment amounts (SPAs) for the Off-The-Shelf (OTS) Back Braces and OTS Knee Braces product categories included in Round 2021 of the Durable Medical Equipment, Prosthetics, Orthotics, and Supplies (DMEPOS) Competitive Bidding Program (CBP) and began awarding contracts in certain competitive bidding areas (CBAs).
Winning bidders for the OTS Back and Knee Brace product categories have received Round 2021 contract offers in Connexion, the DMEPOS CBP’s secure portal. Winning bidders need to respond to the contract offers no later than 8:59:59 p.m. prevailing Eastern Time on November 10, 2020.
There will be no Round 2021 competitive bidding contracts awarded for product categories other than OTS Back Braces and OTS Knee Braces. Please see the CMS announcement, here, for additional information. Round 2021 contracts will be effective on Jan. 1, 2021. CMS plans to announce the contract suppliers later this fall. Learn about contract supplier obligations and more on the Competitive Bidding Implementation Contractor (CBIC) website.
“HHS and CMS are making the right call here,” said Tom Ryan, AAHomecare president and CEO, in a statement. “Removing the majority of HME product categories from Round 2021 will allow suppliers to effectively serve their communities as the public health emergency continues, and also provide care for individuals with long-term healthcare challenges as they recover from COVID-19.”
The 13 additional categories were removed from the bidding program as "payment amounts did not achieve expected savings," according to the CMS announcement.
"We appreciate CMS' transparency in sharing that Round 2021 bids didn't result in significant savings," added Ryan. "These products have been bid multiple times, and we've found a payment floor. Competitive bidding should end for these products permanently."
"Once we're clear of this pandemic, policymakers, HME stakeholders, clinician organizations and patient groups should take advantage of the opportunity to develop a new system for Medicare reimbursements," Ryan added. "It's time to move on to a better approach that expands access to HME as the patient population that depends on these products and services continues to grow."
“I want to thank leadership at HHS and CMS for their decisive action,” Ryan said. “These agencies have made strategic moves to relax regulatory requirements and allow healthcare providers to operate more effectively during the pandemic, and this announcement is another example of their strong response to this crisis.”
In addition to announcing Round 2021 payment amounts, CMS released a long-awaited proposed rule on Medicare DMEPOS payment policy that proposes:
- Continuing current relief for rural HME suppliers (50/50 blended rate). Other non-bid area suppliers will be paid at 100% of the adjusted fee schedule.
- Exclusion of Complex Rehab manual wheelchairs and certain other manual wheelchairs, and accessories used with them, from the bidding program.
- Changes related to the Healthcare Common Procedure Coding System (HCPCS) Level II Code Application Process
- Changes to the process for making Benefit Category Determinations and Payment Determinations for DME and other Items and services under Part B
- Changes to the classification and payment for Continuous Glucose Monitors under Part B
- Expanded classification of External Infusion Pumps as DME
CMS is considering extending the current transition payment rules that have been in effect in former competitive bid areas during 2019 and 2020 for items in the 13 product categories that have been removed from Round 2021.
“The COVID-19 pandemic underscores the critical role that HME plays in supporting our nation’s healthcare infrastructure,” Ryan concluded. “Going forward, we need to make sure that policymakers and private payers understand that patients, caregivers, clinicians, and communities will benefit with a stronger investment in home-based care.”
The CBIC, under contract with CMS, is the official source for information regarding the DMEPOS CBP. CMS cautions suppliers that neither CMS nor the CBIC independently reviews or verifies information about potential inaccurate information concerning the DMEPOS CBP posted on websites other than the CBIC website or cms.gov. Visit the CBIC website for valuable resources and tools and to subscribe to email updates.
If you have any questions or need assistance, please call the CBIC customer service center at (877) 577-5331 between 9 a.m. and 5:30 p.m. prevailing Eastern Time, Monday through Friday.
Updated Wednesday, 10-28-2020, 8:30 a.m. to include statements from Tom Ryan and additional context.
