Medicare will pay for those services if they are needed to maintain a person’s ability to perform routine activities of daily living or to prevent deterioration of the person’s condition, the courts said. Medicare beneficiaries do not have to prove that their condition will improve, as the government sometimes contends, the courts said.
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CMS: All Competitive Bidding Suppliers Meet Financial Standards
CMS stated that all of the DMEPOS supply firms signing contracts meet the agency’s financials standards as well as other requirements including quality standards and state licencing requirements.
CMS declined to state whether any contract offers were withdrawn during the delay in naming the winners.
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CMS to Send Brochure to Beneficiaries
With just under two months remaining until start of Round 1 implementation and the holiday season upcoming, CMS announced that they will send letters and brochures to beneficiaries in competitive bidding areas explaining the changes that will take place in how they obtain home medical equipment.
The mailings which are expected to go out early next week are part of an educational effort by the agency to try ensuring that beneficiaries maintain continuity of life-sustaining care.
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No Delay in Round 1 Implementation
CMS announced today (11/3) that Round 1 would be implemented on January 1. 2012.
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Medicare Standards Are Too Strict, 2 Courts Find
From: New York Times
Medicare Standards Are Too Strict, 2 Courts Find
By ROBERT PEAR
WASHINGTON — Two federal courts have ruled that the Obama administration is using overly strict standards to determine whether older Americans are entitled to Medicare coverage of skilled nursing home care and home health care.
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Kansas: Medicaid to adopt competitive bidding pricing
TOPEKA, Kan. – The other shoe has dropped in Kansas.
The state Medicaid program in September notified the Midwest Association of Medical Equipment Services (MAMES) that it plans to adopt competitive bidding pricing on Jan. 1. The good news: It doesn’t look like it will apply the pricing–on average, 32% below the current pricing for nine product categories–across the board.
The way stakeholders understand it, the state plans to apply the pricing only for dual-eligible beneficiaries who have both Medicare and Medicaid coverage, and for beneficiaries who live in the Kansas City competitive bidding area.
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CMS Set To Announce Round-One DME Contract Suppliers
Posted: October 28, 2010CMS may announce as early as Friday (Oct. 29) the contract suppliers for the first round of the durable medical equipment competitive bidding program, industry sources say, though other insiders suggest it “may slide” until next week and CMS would not confirm the date. A CMS e-mail to industry states that the agency is holding a Nov. 8 call with medical equipment suppliers who did not win contracts under the first round of the competitive bidding program for durable medical equipment (DME), which is an indication that CMS does not plan to postpone the round-one bid start date, sources say — even though several lawmakers are questioning the program’s design, and one House Democrat is calling for a delay to the first round.
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The Need For A Delay
Rep. Bruce Braley wrote to Secretary Sebelius and CMS Administrator Berwick this week advising them of the need to delay implementation of the DMEPOS competitive bidding program in light of the program’s flaws analyzed by Dr. Peter Cramton and supported by over 160 academicians. As Rep. Braley explained:
As custodians of the Medicare program charged with ensuring appropriate access, CMS has the administrative authority to delay implementation of the bid program. The Economists’ statement demonstrates the fatal flaws in the policy decisions that have been made — it demonstrates that the bidding program will simply not work because of fundamental design flaws, harming beneficiaries. Therefore, CMS should delay Round 1 of the bid program until a bid program is crafted that is consistent with Congress’ expectations, and consistent with the parameters detailed by leading experts in the field.
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1/1/11: The Artificial Deadline
CMS’ January 1st start date for implementing Round 1 contracts is a timeframe of their own choosing. Moreover, it is not a hard deadline. The date is not set in statute and CMS’ website describes it as a “Target date” and noted that the “Actual date will be announced through listserv notice.”
In light of the numerous problems with the Round 1 bidding, the most recent being the delay in announcing the bid winners, CMS needs to delay the January 1st implementation date. The delay is needed, for among other reasons, because the delays in announcing the bid winners has resulted in an unacceptably short transition period for both providers and beneficiaries. To dely the date, CMS needs to do nothing more than send out a listserv announcement.
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CMS Replaces Storefront Fraud with Bidding Fraud
In a very informative Home Care Magazine article reprinted below, the writer identified many of the fatal flaws in CMS’s DME competitive bidding program. CRE is accurately quoted in the article as stating that CMS has established a program that encourages fraudulent bidding since the bids are not binding (see last paragraph). Therefore, at the same time CMS is working to combat storefront fraud, they are opening the door to a new type fraud, although one that is much harder to detect. Professor Cramton and his 160+ co-signatories warned that under CMS’ bidding program, “fraud and abuse would grow.”
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CRE’s Tozzi: Call in the Exterminator
From: Home Care Magazine
WASHINGTON — According to Jim Tozzi of the Center for Regulatory Effectiveness, the theory behind various types of auctions has been studied by economists for fifty years — and he thinks CMS should have studied it a little harder.
On Monday, the Washington-based regulatory watchdog organization sent a letter under Tozzi’s signature requesting that CMS postpone Round 1 of competitive bidding “until the agency’s auction rules are revised to conform with accepted [principles].”
Tozzi cited a Sept. 26 letter to Congress from University of Maryland economist Peter Cramton and more than 160 others blasting the bid program’s flaws.