WASHINGTON, DC – At this point, there is every indication that CMS plans to move forward with implementing Round 2021 of the Medicare DMEPOS competitive bidding program on January 1, 2021. It’s time for DME providers across the country to urge Congress to require CMS to delay the Round 2021 DME competitive bid program. Moving forward with the competitive bidding program will impede patient access given the current economic and care delivery landscape caused by the COVID-19 public health emergency.
There are compelling reasons for Congress to delay the Round 2021 competitive bidding program. First, beneficiary access issues will occur because, by design, the program reduces the number of DME suppliers who can serve beneficiaries in bid areas. And the 100 bid areas are the most densely populated geographic areas, the same areas most hard hit by the coronavirus.
Second, the COVID-19 pandemic has dramatically changed the product and operational cost structure, disrupting the supply chain. Since bidders developed and submitted their bid prices before the COVID-19 pandemic, those bids do not take into account supply chain disruptions, higher costs from the pandemic, and are therefore invalid as they no longer represent suppliers’ costs to provide care.
The important bidding program metrics of “expected supplier capacity” and “expected product demand,” which determine the eventual number of contractors, are no longer accurate due to the increased utilization of respiratory and related DME items due to the pandemic. The number of suppliers necessary to serve the increased number of respiratory beneficiaries, due to COVID-19, is significantly more than what would have been required under 2017 and 2018 utilization estimates.
Finally, the DME industry provides a critical safety net for beneficiaries, effectively easing hospital overflow issues during the pandemic. By keeping patients out of hospitals and other health care institutions, DME suppliers are making a material positive contribution to this country’s handling of an unprecedented health care crisis.
CMS has already correctly decided to remove non-invasive ventilators (NIVs) from Round 2021 of the competitive bidding program, recognizing that it is important to ensure beneficiary access to these critical items and services, particularly in cities most hard hit by the coronavirus. CMS must recognize that access to other respiratory and DME items is as necessary, and in some cases more so, as NIVs.
During this public health emergency, DME providers have experienced a dramatic increase in patients requiring home oxygen and other respiratory items and services in the areas most impacted by the COVID-19 pandemic. Respiratory devices such as CPAP, RADs, and home oxygen are being prescribed for patients with the COVID-19 virus as well as for patients with acute and chronic conditions. Restricting the availability of home respiratory therapies, which is a necessary byproduct of the competitive bid program, must be reconsidered in a marketplace disrupted by the virus spread.
The time to act is now. The sooner CMS makes the decision to delay the competitive bid program the better, and administratively simpler. Please contact your U.S. Senators’ and Representatives’ offices and urge them to contact CMS and request that CMS delay the competitive bidding program for one year.
Contacting your legislators’ offices during the COVID-19 pandemic is the same as during “normal” times. Some staff are working at home, some are in the office, but all are connected via e-mail and telephone. As usual, it’s best to first send the health staff an e-mail asking for a call.
For AAHomecare’s Position Paper you can use with legislators, click here. To have your company employees quickly send their U.S. House and Senate legislators a letter, click on the AAHomecare Action Center link and follow the prompts.
Cara C. Bachenheimer, J.D., is chair of the Government Affairs Practice Group at Brown & Fortunato, a law firm based in Amarillo, Texas. Bachenheimer is based in Washington, D.C. She represents DME companies, other providers, and manufacturers throughout the United States, and can be reached at (806) 345-6321 or [email protected].
