WASHINGTON, D.C. – With Labor Day behind us, CMS’ “Late Fall” competitive bidding bid window opening is fast approaching. Suppliers intending to submit bids for the DMEPOS remote item delivery (RID) competitive bidding program (CBP) will have to be in compliance with all pre-requisites by the close of the bid window.
One of the most important prerequisites is compliance with all U.S. state and territory licensure requirements. All locations on a supplier’s bid must collectively meet all applicable licensing requirements for every item in the product category in which the bidder bids. During the bid evaluation process, CMS will check bidders’ licenses through PECOS. CMS states that it will confirm that each of the locations (identified by a PTAN) listed on the bid meet all applicable requirements.
State licensure information can be found on the CMS enrollment contractor web sites, NPEast and NPWest. And while DMEPOS suppliers are responsible for ensuring they are in compliance with all state and federal laws and regulations, the licensure database serves as an important starting point to understand which states require licensure to provide DMEPOS items to residents in their respective states and territories.
On the CBIC website, CMS states that these databases are only a guide, that licensing rules can change, and it is the bidder’s responsibility to ensure licenses are current and reflected in PECOS by the close of the bid window. Most important is that bidders confirm directly with legal counsel and/or the state licensing agencies to confirm their licensing requirements.
Recently, the NPEast and NPWest state licensure have been updated, reflecting different licensure requirements for certain CBP RID product categories. For example, in late August 2026, the NPEast licensure database updated New York licensure requirements for ostomy supplies and urological supplies. NPWest has recently changed licensure information for ostomy supplies for California, Louisiana, Oklahoma, Montana and Utah. Further, it appears that some state licensure information in the licensure database is not accurate for the particular product categories. We have also found that while NPEast provides a summary of when it made updates to the licensure database; it does not appear that NPWest provides that important information. It is therefore important to check back regularly and compare licensure details from original research and the enrollment contractors’ licensure databases.
Aside from the question of why the enrollment contractor licensure databases have been updated recently when it appears many of these states have not recently changed their state licensure requirements, the more practical question is what information will CMS rely upon when vetting bidders, particularly where the bidder believe the licensure database is inconsistent with the actual state licensure requirements?
The American Association for Homecare (“AAHomecare”) has brought to CMS’ attention the fact that the enrollment contractors’ databases information continues to change – and does not appear to be 100 percent accurate. AAHomecare has also asked CMS, as part of a series of many questions for CMS to clarify regarding the details of the RID programs, what information it will use to verify state licensure requirements when they vet bidders. We are concerned that CMS may use inaccurate information that is housed in the enrollment contractors’ licensure databases. AAHomecare has urged CMS, when vetting bidders, to connect directly with bidders to allow the supplier an opportunity to demonstrate compliance before any adverse licensure determination is made. This is particularly important where the enrollment contractor licensure databases may not be consistent with actual state licensure requirements.
Six-Month Transition Period
Another pressing issue that AAHomecare has communicated with CMS about is the “six-month transition period” that starts when the RID contracts begin.
On its competitive bid website (www.dmecompetitivebid.com), CMS has stated that there is a “six-month transition (grace) period for contract suppliers to obtain written orders for patients transitioning to them from non-contract suppliers beginning on or after January 1, 2028.”
This appears to mean that contract suppliers may submit claims, for dates of service between January 1 and June 30, 2028, without a signed written order, or any other documentation that substantiates medical need. This transition policy, however, presents several practical issues.
From an audit perspective, how will CMS and its audit contractors identify claims where the signed order is after the date of service as part of this transition policy? How will CMS ensure
these claims will not be overturned? On a more immediate basis, how will contract suppliers know, during the transition period, if the beneficiary qualifies for the item? How will contract suppliers know if the beneficiary had a physician visit within the last year to recertify medical need? Contract suppliers will need some assurance that the beneficiary meets the medical need criteria.
The RID competitive bid program presents numerous challenges, and it is important to stay up to date as new information is released. Make sure to visit the government’s web site at www.dmecompetitivebid.com and AAHomecare’s site at www.aahomecare.org.
Cara C. Bachenheimer, Esq., is an attorney with the Health Care Group at Brown & Fortunato, a law firm with a national health care practice based in Texas, where she heads up the firm’s Government Affairs Practice. Bachenheimer’s practice focuses on federal lobbying activities with Congress, the Administration, and federal regulatory agencies, such as CMS, FDA, IRS, and FAA. She can be reached at (806) 345-6321 or [email protected].
Jacque K. Steelman, Esq., is a member of the Health Care Group at Brown & Fortunato, PC, a law firm with a national healthcare practice based in Texas. She represents pharmacies, infusion companies, HME companies, manufacturers, and other healthcare providers throughout the United States. Ms. Steelman can be reached at (972) 684-5789 or [email protected].