WASHINGTON, D.C. – CMS confirmed that legacy product categories like oxygen, Group 2 power wheelchairs, CPAP, hospital beds, and others included in previous bidding rounds will not be part of the Competitive Bidding Program (CBP) set to begin next year.
This news has been broadly celebrated by many DME suppliers who will not have to go through another bidding round and potentially lose access to serving Medicare beneficiaries. However, other provisions from the Final Rule with impacts on the DME community, patients, and caregivers are still in place. AAHomecare is beginning work on the next phase of its advocacy related to the proposed rule to address these significant issues that remain.
RID Competitive Bidding Program
The new bidding round will include products that will be furnished by Remote Item Delivery (RID): Class II CGMs & Insulin Pumps, Urological Supplies, Ostomy Supplies, Hydrophilic Urinary Catheters, and OTS Braces. Using 2023 utilization data, AAHomecare estimates that CMS processes for implementing a nationwide RID bid program will result in fewer than 10 suppliers “winning” bids and serving patients in ostomy, CGMs/insulin pumps, and urological supplies categories.
Payment Setting Methodology/Bid Ceiling
CMS’ process for determining the Single Payment Amount (SPA) for these products is set at the 75th percentile of bids needed to meet market demand. In addition, the new bidding process will utilize the current fee schedule as the bid ceiling for these products (with the exception of braces), instead of using the 2015 unadjusted SPA as a ceiling (as used in the last bidding round). Using these mechanisms severely limits the prospects of delivering payment amounts that reflect market reality for suppliers.
This payment setting methodology will impact bidders under the RID Bidding Round in the near term – but also sets a worrying precedent for any possible future bidding rounds.
Provider Enrollment and Annual Accreditation
The Final Rule includes overly-restrictive provider enrollment changes, including a provision noting that a supplier’s Medicare number can be revoked if the beneficiary attests that they never received the item or service listed in the supplier’s claim. AAHomecare officials have followed up with CMS on this point and have been told there will be an investigation process before any revocation. They will be advocating on behalf of the industry to limit potential burdens for other newly implemented enrollment policies.
The Final Rule also moves Accreditation from an every-three-year schedule to an annual basis. AAHomecare is also working with CMS and accreditation organizations to limit the impact of this change on suppliers. See the slide deck from a recent webinar on the Final Rule for additional information on major provisions in this new regulation.
What’s Next
AAHomecare is committed to continuing the fight to delay or improve the RID Bidding Program – and they’ve already started to engage policymakers on the issue. Advocates met last week with HHS policy staff to further discuss bidding for CGMs/Insulin Pumps, Ostomy Products, and Urologicals and its impacts on suppliers and patients.
The next phase of the campaign will build on relationships developed with the White House and the Domestic Policy Council, OMB, HHS, and CMS – and continue to utilize the additional lobbying support that helped to reach decision makers in the Administration. AAHomecare is also engaging allies in Congress to assess the prospects of a legislative solution to address the RID Bidding Program.
Not Easing Up
CMS’ decision to exclude legacy products from the next round of the CBP was an important and hard-fought win. At the same time, this outcome does not bring relief to everyone. For members whose products remain subject to bidding, or those whose reimbursement is still anchored to outdated, CBP-derived rates in non-bid areas, the pressure is real. For some, it threatens the viability of their businesses and the care their end users depend on.
AAHomecare is not easing up. Advocacy continues with full urgency on behalf of those impacted, and this recent win strengthens the ability to press forward. With the legacy products being excluded from the next round, there is an even greater capacity to focus fully and relentlessly on the urgent issues ahead. This includes continued efforts to delay the next bid round or improve its framework while also addressing the broader reimbursement pressures that continue to impact members in former bid and non-bid areas as well as other payers.
AAHomecare is focused, relentless, and fighting alongside you for solutions to protect your business and the communities you serve. It’s time to build on 2025 success to address the challenges that remain with the RID bidding program and to further strengthen advocacy capabilities in 2026 – and bring home more wins for HME.
