The Durable Medical Equipment, Prosthetics, Orthotics, and Supplies (DMEPOS) Competitive Bidding Program

1. The Durable Medical Equipment, Prosthetics, Orthotics, and Supplies (DMEPOS) Competitive Bidding Program What You Need to Know

2. Competitive Bidding– A Better Way to Pay • Program started in January 2011 for certain DMEPOS in nine areas of the country (Round 1) • Program helps people with Medicare • Save money • Get quality equipment, supplies and services • Program strengthens protections against Medicare fraud Competitive Bidding Program

3. How the Program Works • DMEPOS suppliers submit bids • Suppliers must submit a bid to be considered for contract award • Payment amounts based on bids • Contracts are awarded to winning suppliers to sell/rent DMEPOS • Contract suppliers must • Meet eligibility, quality, and financial standards • Be accredited by an independent organization Competitive Bidding Program

4. How the Program Works • In most cases, only contract suppliers can • Provide competitively bid DMEPOS items • File claims with Medicare for payment of competitively bid items and services • Contract supplier charge cannot exceed • Single payment amount based on bids received for an item • Medicare fee schedule allowed amount Competitive Bidding Program

5. Round 1 Rebid Round 1 Rebid resulted in savings of 35% below fee schedule Savings for first two years over $400 million Competitive Bidding Program

6. Round 1 Recompete Current competitive bidding program supplier contracts in Round 1 areas end December 31, 2013 (national mail-order program remains in effect) Round 1 Recompete contracts go into effect on January 1, 2014 in same nine areas Round 1 Recompete projected to result in savings of 37% compared to fee schedule Competitive Bidding Program

7. Round 1 Rebid Products 1/1/11-12/31/13 * Competitive Bidding Program

8. Round 1 Recompete Products 1/1/14-12/31/16 Competitive Bidding Program

9. Who will be Affected? • Round 1 areas: • Charlotte-Gastonia-Rock Hill (North Carolina and South Carolina) • Cincinnati-Middletown (Ohio, Kentucky and Indiana) • Cleveland-Elyria-Mentor (Ohio) • Dallas-Fort Worth-Arlington (Texas) • Kansas City (Missouri and Kansas) • Miami-Fort Lauderdale-Pompano Beach (Florida) • Orlando-Kissimmee-Sanford (Florida) • Pittsburgh (Pennsylvania) • Riverside-San Bernardino-Ontario (California) • Medicare Advantage enrollees use suppliers designated by their plan Competitive Bidding Program

10. Using Contract Suppliers • Must almost always use contract supplier if • Items and services are included in Competitive Bidding Program where a beneficiary lives • Traveling to or visiting a CBA • Doctors, treating practitioners, and hospitals can supply certain items (ex: walkers, folding manual wheelchairs and external infusion pumps) without being contract suppliers • Nursing Facility can supply directly to its own residents only if it becomes a contract supplier Competitive Bidding Program

11. Identifying Contract Suppliers • Visit the DMEPOS Supplier Locator tool • www.medicare.gov/supplier • Call 1-800-MEDICARE (1-800-633-4227) • TTY users call 1-877-486-2048 Competitive Bidding Program

12. Stay With Current Supplier • Can stay with current supplier that doesn’t have a new contract if (ALL of the following): • Supplier elects to become “grandfathered” • Beneficiary permanently resides in a CBA • Renting certain equipment or oxygen when program starts in CBA • If current supplier did NOT win a new contract AND elects NOT to become “grandfathered” • Must generally use a supplier that has a new contract Competitive Bidding Program

13. Grandfathering Non-contract supplier Issues written notice saying if it is willing to continue renting equipment Works with contract supplier to get new equipment to beneficiary if beneficiary switches to contract supplier Beneficiary May continue getting services from grandfathered supplier until rental period ends OR May switch to a new contract supplier Competitive Bidding Program

14. Have Other Insurance? • Medicare may make payment to a non-contract supplier if required by primary policy • Non-contract supplier must • Be accredited • Have valid Medicare billing number • Be eligible to receive secondary payments Competitive Bidding Program

15. Non-contract Supplier • A non-contract supplier generally may not furnish competitively bid items in a CBA • If non-contract supplier used and no exception applies, beneficiary not responsible for payment unless supplier issues Advance Beneficiary Notice (ABN) • Says Medicare will not pay • By signing ABN, beneficiary agrees to pay entire amount Competitive Bidding Program

16. Changing Suppliers Scenario Obtaining DMEPOS items from a new contract supplier Mildred’s permanent residence is in Miami, FL which is a Round 1 CBA. She is currently renting her Continuous Positive Airway Pressure (CPAP) device from ABC company, which has a Round 1 Rebid contract but not a Round 1 Recompete contract. Mildred receives a notice from ABC company informing her that they won’t be a contract supplier after December 31, 2013 and that they also won’t be a grandfathered supplier starting January 1, 2014. Mildred must transition to a Round 1 Recompete contract supplier for Medicare to help pay. Competitive Bidding Program

17. Traveling Beneficiaries To CBA: Must generally use contract supplier for that CBA If non-contract supplier used and no exception applies, beneficiary not responsible for payment unless supplier issues Advance Beneficiary Notice (ABN) To non-CBA: Can use any Medicare-enrolled supplier Competitive Bidding Program

18. Specific Brands • Doctor must prescribe in writing • Medical record must reflect need • Contract supplier must • Furnish the specific brand or form as prescribed OR • Work with doctor or treating practitioner to find suitable alternative and obtain a revised prescription OR • Help locate another contract supplier that can furnish the specific brand or form as prescribed Competitive Bidding Program

19. Equipment Repair & Replacement • For owned medical equipment • Any Medicare-enrolled supplier can make necessary repairs • For replacement must use contract supplier • For warranty repairs, follow the warranty rules • For rented equipment • Repairs are included in rental payment – the supplier must fix at no charge Competitive Bidding Program

20. Deductible and Coinsurance • After beneficiaries pay their annual Part B deductible • Medicare pays 80% of the Medicare-approved amount for equipment, supplies and services • Beneficiaries are responsible for a 20% coinsurance • Contract suppliers cannot bill for more than these amounts • For suspected overpayment or fraud call • 1-800-MEDICARE (1-800-633-4227) • TTY users call 1-877-486-2048 • Fraud Hotline of the HHS Office of Inspector General at 1-800-447-8477. Competitive Bidding Program

21. Points to Remember Program does NOT affect which physicians or hospitals beneficiaries use Generally must use contract supplier for Medicare to help pay May be able to stay with current supplier if renting from supplier who has new contract or elects to become “grandfathered” If in Medicare Advantage plan, beneficiary should check with the plan Competitive Bidding Program

22. What Beneficiaries Need To Do • Beneficiaries who live in or will visit a CBA and need medical items included in the program, should • Find out if the ZIP Code where they live or visit is included in a CBA • Find out if the items they need are included in the Medicare Competitive Bidding Program in that area • Find out which suppliers are contract suppliers for their items for the Medicare Competitive Bidding Program • Visit www.medicare.gov/supplier or • Call 1-800-MEDICARE (1-800-633-4227) to find this information • TTY users call 1-877-486-2048 Competitive Bidding Program

23. Questions? • Visit www.medicare.gov/supplier • DMEPOS Supplier Locator Tool • Visit www.medicare.gov website • Consumer information • Call 1-800-MEDICARE (1-800-633-4227) • TTY users should call 1-877-486-2048 • Beneficiary’s physician or supplier • Medicare’s local information resources (SHIPs, ACL, etc) Competitive Bidding Program

24. Stay Informed Visit www.cms.gov/Medicare/Medicare-Fee-for-Service-Payment/DMEPOSCompetitiveBid Competitive Bidding Program