CMS's Proposed Rule on Competitive Acquisition for Durable
Medical Equipment, Prosthetics, Orthotics, and Supplies Affects Occupational
Therapists
Overview
The Centers for Medicare & Medicaid Services (CMS)
issued its proposed rule on competitive acquisition on May 1,
2006. This proposal details the implementation of competitive
bidding programs for certain covered items of durable medical
equipment, orthotics, prosthetics, and supplies (DMEPOS). The
way these items are paid for under Medicare Part B would
change. Under the proposed rule, competitive bids would be
submitted by DMEPOS suppliers to establish the payment amounts
for particular items. Also under the proposed rule,
occupational therapists who wished to bid to compete as a
potential supplier of items, such as orthotics, would be
required to comply with the following provisions in order to
supply these items to therapy patients.
Timeline and Selection of Competitive Bidding
Areas
The bidding program is being phased in throughout the county
over the next 3 years under the following schedule:
- Implemented in 10 of the largest metropolitan statistical
areas (MSAs) in 2007
- Implemented in 80 of the largest MSAs in 2008
- Additional areas added after 2009
Although CMS did not announce the 10 MSAs where competitive
bidding will begin, the agency stated that it will focus its
attention on the MSAs with the highest totals of DMEPOS-allowed
charges to produce the greatest chance of Medicare cost
savings. However, CMS proposed to exclude the three MSAs with a
population of more than 9 million (New York, NY; Los Angeles,
CA; and Chicago, IL) from the 2007 implementation in order to
obtain more experience from smaller MSAs.
Selection of Items and
Services
CMS proposes to group similar items used for patient
treatment into product categories (such as hospital beds and
accessories) so that beneficiaries will be able to receive all
related items in the product category from one supplier to
minimize disruption of services. CMS proposes to identify the
20 top product categories in terms of total Medicare spending,
from which the items or groups of items for inclusion in the
bidding process would be selected for the first phase of the
program.
Occupational therapists should know that Off-the-Shelf (OTS)
Orthotics will be subject to competitive bidding. OTS orthotics
are identified in the rule as those that generally require
minimal self-adjustment for appropriate use and do not require
expertise in trimming, bending, molding, assembling, or
customizing to fit the individual. CMS specifically proposes
that "minimal self-adjustment" means adjustments that
the patient, caretaker, or supplier can make without the
assistance of a certified orthotist (one certified by the
American Board for Certification in Orthotics and Prosthetics
[ABC] or the Board for Orthotist/Prosthetist Certification
[BOC]). The American Occupational Therapy Association (AOTA)
will argue that licensed occupational therapists have the
education and skill necessary to perform these adjustments to
OTS orthotics.
The proposed rule does not address custom-fabricated
orthotics at all, suggesting that these items are not
going to be subject to the competitive bidding process.
Bidding
CMS proposes that the Medicare payment amounts would be set
at the median of the winning suppliers' bids for selected
items. CMS proposes that the implementation of the bidding
process would be conducted by Competitive Bidding
Implementation Contractors (CBICs). CBICs would be entities
separate from Durable Medical Equipment Regional Carriers
(DMERCs) and would oversee the bid process, educate DMERCs
regarding claims processing, and administer grievances
processes, among other duties.
Quality Standards and Accreditation of DMEPOS
Suppliers
The proposed rule also discusses two issues related to the
competitive bidding, but CMS will formally address these issues
in other proposals that are expected this summer. The issues
are quality standards that all suppliers must meet in providing
DMEPOS, and accreditation of suppliers. Both are in other new
sections of law. Accreditation requires that all DMEPOS
suppliers, including occupational therapists who supply DMEPOS,
must obtain some sort of accreditation from a CMS-approved
accreditation organization (regardless of whether the supplier
chooses to participate in competitive bidding). The
accreditation organizations CMS chooses will also be
responsible for applying quality standards to all DMEPOS
suppliers. Failure to meet the standards can result in the
revocation or suspension of billing privileges and the
inability to participate in the Medicare competitive bidding
program. The competitive bidding rule does not specify what the
accreditation and quality standards will be, but merely states
that entities submitting bids as suppliers will have to meet
those accreditation requirements when they are issued. The
competitive bidding rule does not identify which accreditation
organizations or authorities will be designated by CMS.
Draft quality standards were issued by CMS several months
ago, and are expected to be issued in final form by Medicare
Program Transmittal this summer. AOTA submitted
comments on
the draft quality standards in November 2005.
Through meetings and written comments to CMS, AOTA will
continue to fight to assure that the accreditation requirements
and the quality standards protect occupational therapists'
right to supply orthotics. AOTA's position on accreditation
is to urge CMS to consider state licensure and completion of an
education at an accredited program of occupational therapy—the
same standards that CMS already relies on as proof of
qualification for providing occupational therapy services to
Medicare beneficiaries—as meeting the accreditation standards.
Physician Treatment
In the proposed rule, CMS treats physicians differently from
all other providers. Physicians would, however, still be
required to participate in the bidding process to be able to
supply competitively bid items. CMS states that physicians
would not be required to furnish items to beneficiaries who are
not their patients if a physician chooses not to function as a
"commercial supplier." AOTA plans to seek
clarification of the term "commercial supplier," and
to comment that occupational therapists should be treated the
same as physicians under the proposed rule.
AOTA Encourages OTs to Submit Comments
CMS is requesting comments to the proposed rule on a
significant number of topic areas. AOTA strongly encourages
members who are affected by this rule to submit timely
comments. To be assured consideration, comments must be
received by CMS no later than 5 p.m.
on June 30, 2006. Comments
can be submitted electronically directly to CMS at http://www.cms.hhs.gov/eRulemaking
AOTA also requests that members send comments and feedback
to rrpd@aota.org by
5 p.m. on June 28, 2006, for incorporation into
AOTA's official comments on the competitive acquisition
proposed rule.
Read the
full text of the proposed rule.
Last Update: 05/18/06
