CHAP - CMS Release - Medicare Program; Payment Policies Under the Physician Fee Schedule and Other Revisions to Part B for CY 2011
Nov 3, 2010
The Centers for Medicare & Medicaid Services (CMS) has announced that the following final rule is on display at the Federal Register:
Medicare Program; Payment Policies Under the Physician Fee Schedule and Other Revisions to Part B for CY 2011
The rule (CMS-1503-FC) can be viewed at:
http://www.cms.gov/PhysicianFeeSched/PFSFRN/list.asp#TopOfPage
This final rule includes provisions regarding the following DMEPOS subjects that impact the Medicare DMEPOS Competitive Bidding Program:
The establishment of an appeals process for competitive bidding contract suppliers that are notified that they are in breach of contract.
The subdivision of metropolitan statistical areas (MSAs) with populations over 8,000,000 into smaller competitive bidding areas (CBAs), in particular Chicago, New York and Los Angeles.
The addition of 21 MSAs to the 70 MSAs already included in the Round 2 Competitive Bidding program, for a total of 91 MSAs.
The addition of the following policies affecting future competitions for diabetic testing supplies following Round
Revision of the definition of a “mail order” item to include any item shipped or delivered to a beneficiary’s home, regardless of the method of delivery;
Requirement that bidding suppliers demonstrate that their bid covers types of diabetic testing strip products that, in the aggregate and taking into account volume for the different products, cover at least 50 percent of the types of test strips products on the market; and
Prohibition of contract suppliers from influencing or incentivizing beneficiaries to switch types of test strips or glucose monitors.
The exemption of off-the shelf orthotics from competitive bidding when provided by a physician to his or her own patients or a hospital to its own patients.
The elimination of the lump sum purchase option for standard power wheelchairs furnished on or after January 1, 2011, and adjustments to the amount of the capped rental payments for both standard and complex rehabilitative power wheelchairs.
Appeals Process We finalized, in the final rule, an appeals process for suppliers who have been notified that they are in breach of their DMEPOS competitive bidding contract. Depending on the circumstances, suppliers initially will either be afforded a process for submitting a corrective action plan or request a hearing prior to termination of the contract. The appeals process will ensure that suppliers have appeal rights and that they receive an opportunity to be heard before their contract is terminated.
We finalized, in the final rule, an appeals process for suppliers who have been notified that they are in breach of their DMEPOS competitive bidding contract. Depending on the circumstances, suppliers initially will either be afforded a process for submitting a corrective action plan or request a hearing prior to termination of the contract. The appeals process will ensure that suppliers have appeal rights and that they receive an opportunity to be heard before their contract is terminated. Subdivision of the Metropolitan Statistical Areas (MSA) Medicare Improvements for Patients and Providers Act of 2008 (MIPPA) allows us to subdivide MSAs with populations over 8,000,000 into smaller CBAs. We will subdivide the three largest MSAs: Chicago-Naperville-Joliet, IL-IN-WI; Los Angeles-Long Beach-Santa Ana, CA; and New York-Northern New Jersey-Long Island, NY-NJ-PA. We finalized the regulation to subdivide MSAs along county lines as we believe county lines are well-defined and more static.
Medicare Improvements for Patients and Providers Act of 2008 (MIPPA) allows us to subdivide MSAs with populations over 8,000,000 into smaller CBAs. We will subdivide the three largest MSAs: Chicago-Naperville-Joliet, IL-IN-WI; Los Angeles-Long Beach-Santa Ana, CA; and New York-Northern New Jersey-Long Island, NY-NJ-PA. We finalized the regulation to subdivide MSAs along county lines as we believe county lines are well-defined and more static. Addition of 21 MSAs to 70 MSAs The Affordable Care Act requires that we expand Round 2 of the competitively bidding program by adding an additional 21 of the largest MSAs based on total population to the original 70 already selected for Round 2. We have included this requirement in the regulation.
Diabetic Testing Supplies MIPPA specifies that a national competition for mail order items and services is to be phased in after 2010. The regulation includes provisions to implement a national mail order competition for diabetic supplies in 2011 that includes all home deliveries while maintaining the local pharmacy pickup choice for beneficiaries. We are also implementing the special “50 percent rule” mandated by MIPPA and implementing an anti-switching requirement as part of the terms of the competitive bidding contract.
Exemption of Off-the Shelf (OTS) Orthotics from CBP This regulation implements the MIPPA requirement to extend the competitive bidding exception to OTS orthotics furnished by: (1) a physician or other practitioner (as defined by the Secretary) to the physician’s or practitioner’s own patients as part of the physician’s or practitioner’s professional service; or (2) a hospital to the hospital’s own patients during an admission or on the date of discharge from the hospital.
Elimination of Additional Rental Payments The regulation also solicited comments on whether to maintain the additional rental payments made to contract suppliers when a beneficiary does not continue to get capped rental or oxygen equipment from his or her current supplier. We received nine public comments on this rule and will take them under consideration for future proposed rulemaking. In addition to the competitive bidding rules, this regulation addresses the following payment policies for power-driven wheelchairs and oxygen and oxygen equipment:
Lump Sum Purchase Option for Standard Power Wheelchairs do not apply to power-driven wheelchairs furnished pursuant to contracts entered into prior to January 1, 2011 as part of the Medicare DMEPOS Competitive Bidding Program. These changes and 6 percent (instead of 7.5 percent) for remaining rental months. Payment is based on the lower of the supplier’s actual charge and the fee schedule amount. of the purchase price for the first three months under the monthly rental method (instead of 10 percent) to pay 15 percent Sections 3136(a)(1) and (2) of the Affordable Care Act required revisions to the regulations to eliminate lump sum (up-front) purchase payment for standard power-driven wheelchairs and permit payment only on a monthly rental basis for standard power-driven wheelchairs. For complex rehabilitative power-driven wheelchairs, the regulations will continue to permit payment to be made on a lump sum purchase method or a monthly rental method. Also, payment adjustments required by the statute were made for power-driven wheelchairs under the Medicare Part B DMEPOS fee schedule
Oxygen and Oxygen Equipment month find suppliers to furnish the oxygen and oxygen equipment. We will consider implementing this regulatory change in the future if we determine that beneficiaries are having difficulty locating suppliers when they relocate during the 36-month rental period.th month rental payment and before the 36-month rental at this time due to evidence that beneficiaries who relocate before the 36thWe have decided not to finalize this proposed revision for situations where a beneficiary relocates on or after the 18 These provisions are found in Sections H, N, P, Q, and R of the 2011 Physician Fee Schedule final rule, which is now on display at the Office of the Federal Register. The final rule (CMS-1503-FC) is available at http://www.cms.gov/PhysicianFeeSched/PFSFRN/list.asp#TopOfPage