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For FADONA Members Only
 

CMS Durable Medical Equipment Alert

Your members need to know that Medicare is changing the way it pays for certain durable medical equipment, prosthetics, orthotics and supplies, also known as DMEPOS; what it pays for these items, and who may supply them. These items include for example, hospital beds, diabetic supplies, power wheelchairs and walkers. The new program will begin July 1, 2008 in 10 communities around the country, including Charlotte-Gastonia-Concord, NC-SC; Cincinnati-Middletown, OH-KY-IN; Cleveland-Elyria-Mentor, OH; Dallas-Fort Worth-Arlington, TX; Kansas City, MO-KS; Miami-Fort Lauderdale-Miami Beach, FL; Orlando-Kissimmee, FL; Pittsburgh, PA; Riverside-San Bernardino-Ontario, CA; San Juan-Caguas-Guaynabo, PR.

This change will affect ALL Medicare beneficiaries who need to purchase certain equipment and supplies, and will mean that many Medicare beneficiaries will need to change the suppliers they use for these items if Medicare is to cover them.

Basic background information:

  • This change is the result of the implementation of the Medicare DMEPOS Competitive Bidding Program, which was mandated by Congress as part of the Medicare Modernization Act, the same Act that brought us the Medicare Prescription Drug Program. Once the new program is in place across the country, it is expected to save Medicare and taxpayers about $1 billion each year.

  • By using competition across suppliers, Medicare will pay a lower price that is more in line with current market prices for these items. That also means that beneficiaries, who pay a 20% co-pay for equipment and supplies, will also save money.

Please share this information with your members:

Information You Need: New Medicare-covered Equipment and Supplies Program In Certain Designated Areas

If you order, refer or supply certain medical equipment and supplies, such as oxygen or power wheelchairs, you should know about a new Medicare program that may change the suppliers your patients will need to use.

The new program will begin July 1, 2008 in 10 geographic areas around the country, including Charlotte-Gastonia-Concord, NC-SC; Cincinnati-Middletown, OH-KY-IN; Cleveland-Elyria-Mentor, OH; Dallas-Fort Worth-Arlington, TX; Kansas City, MO-KS; Miami-Fort Lauderdale-Miami Beach, FL; Orlando-Kissimmee, FL; Pittsburgh, PA; Riverside-San Bernardino-Ontario, CA; San Juan-Caguas-Guaynabo, PR. The program will expand to 70 additional areas in 2009 and to additional areas thereafter.

If your patient lives in or travels to one of these 10 designated areas and you order, refer or supply any medical equipment or supplies that fall within the 10 product categories listed below, the patient must now get the equipment or supplies from a Medicare-contracted supplier.

The 10 product categories that are included in the program are:

  • Oxygen supplies and equipment;*

  • Standard power wheelchairs, scooters and related accessories;

  • Complex rehabilitative power wheelchairs and related accessories;*

  • Mail-order diabetic supplies;

  • Enteral nutrients, equipment, and supplies;*

  • Continuous Positive Airway Pressure (CPAP) devices and Respiratory Assist Devices (RADs) and related supplies;

  • Hospital beds and related accessories;*

  • Negative pressure wound therapy pumps and related supplies and accessories;

  • Walkers and related accessories; and

  • Support surfaces, including group 2 mattresses and overlays (in Miami-Fort Lauderdale-Miami Beach, FL only).*

(* Indicates product category is NOT included in San Juan-Caguas-Guaynabo, PR)

To ensure that his or her medical products and services will be covered by Medicare, we encourage you to help your patient find out which suppliers are Medicare contract suppliers. After the suppliers are announced in May, you can find out if a supplier is included in the program by visiting http://www.cms.hhs.gov/CompetitiveAcqforDMEPOS .

For the latest provider information on this new program, CMS has released 3 MLN Matters educational articles, which can be found at:

http://www.cms.hhs.gov/MLNMattersArticles/downloads/SE0805.pdf

http://www.cms.hhs.gov/MLNMattersArticles/downloads/SE0806.pdf

http://www.cms.hhs.gov/MLNMattersArticles/downloads/SE0807.pdf

Once again, if your patient lives in or travels to one of the 10 designated areas and you order, refer or supply any medical equipment or supplies that fall within the 10 product categories, please discuss the new program requirements with your patient, and provide them with the Medicare fact sheet entitled "What You Should Know if You Need Medicare-covered Equipment or Supplies."

http://www.medicare.gov/Publications/Pubs/pdf/11307.pdf