A Medical Device Daily
Senate Finance Committee Chairman Max Baucus (D-Montana) and ranking member Chuck Grassley (R-Iowa) introduced legislation that would delay implementation of the durable medical equipment, prosthetics, orthotics and supplies (DMEPOS) competitive acquisition program (CAP).
The senators said the bill also would make the bidding process more fair and transparent, require suppliers to meet quality standards, and make other improvements to the program.
Introduction of this legislation comes following reports of problems with implementation the program and concerns that the program would result in decreased access to care for Medicare beneficiaries.
"This is important legislation for Medicare beneficiaries," said Baucus. "Durable medical equipment can give seniors the freedom to live at home, and so it's important to maintain a reliable system in Medicare to provide these vital items."
Baucus said he supports competitive bidding as a means of reducing cost, but noted "that cannot be accomplished at the expense of low quality and inconsistent care. The competitive bidding program for durable medical equipment should stay on hold until it's certain that seniors will get the products they need in a way that works for them."
"This legislation will lead to lower prices and higher quality medical products while ensuring that beneficiaries will still have access to the medical equipment and supplies they need," opined Grassley." These improvements also will help prevent many small home medical equipment suppliers from going out of business.
The senators said that they have received numerous reports about potential problems with the implementation of the CAP program. These reports range from suppliers who believe they were wrongly disqualified to questions about the clarity and consistency of information that suppliers received during the bidding process.
Some providers were awarded contracts to serve areas in which they did not previously have a presence. Other suppliers were awarded contracts for service lines with which they have little or no experience.
Under current law, round one of the competitive bidding program is scheduled to begin on July 1. At that time, CMS will begin paying suppliers who have been awarded contracts to provide durable medical equipment, prosthetics, orthotics, and medical supplies to Medicare beneficiaries. CMS would subsequently implement round two in 2009, and following its completion, competitive bidding could be expanded across the country and prices may be adjusted in non-bid areas using information from the bidding program.
Under the Baucus-Grassley bill, contracts awarded under round one would be terminated and re-bid those areas. New round one contracts would then take effect in 18 to 24 months.
Round two contracts could not take effect before January 2011 and payment adjustments for DMEPOS in non-competitive bid areas could not take effect until round two is completed.
The bill also makes improvements to the bidding process used by suppliers, to ensure they are providing the best possible price and service. These changes will help ensure that suppliers who are awarded bids are adequately meeting the needs of Medicare beneficiaries, and protects beneficiaries who might be disadvantaged by the bidding process, such as those who live in rural areas. The legislation also institutes measures to improve the quality of care including requiring accreditation and disclosure of subcontracting relationships.
The legislation is being co-sponsored by more than 20 senators.
CMS awards claims payment contract
The Centers for Medicare & Medicaid Services (CMS) reported that Pinnacle Business Solutions (PBS; Little Rock, Arkansas) has been awarded a contract of up to five years for the combined administration of Part A and Part B Medicare claims payment in Arkansas, Louisiana and Mississippi.
"This is another step toward improving service to beneficiaries and healthcare providers, as well as giving CMS greater oversight of the Medicare contractors that process and pay Medicare claims," said Acting CMS Administrator Kerry Weems. "In awarding these contracts, CMS is ensuring that each Medicare contractor continues to provide the best overall value to the government, and the American taxpayers, from both a cost and technical perspective."
PBS will serve as the first point of contact for the processing and payment of Medicare fee-for-service claims from hospitals, skilled nursing facilities, physicians and other healthcare practitioners in the three states. The new Part A/Part B Medicare Administrative Contractor (A/B MAC) was selected using competitive procedures in accordance with federal procurement rules.
The new contractor will take claims payment work now performed by three fiscal intermediaries and two carriers in the three states. The A/B MAC contract, which has an approximate value of $178 million over five years, will fulfill the requirements of the Medicare Modernization Act's contracting reform provisions, CMS said.
The contract for PBS includes a base period and four one-year options and will provide it with an opportunity to earn award fees based on its ability to meet or exceed the performance requirements set by CMS. These requirements are rooted in CMS' key objectives for the MACs, including enhanced provider customer service, increased payment accuracy, improved provider education and training leading to correct claims submissions, and realized cost savings resulting from efficiencies and innovation.