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Final Rule CMS-1713-F: Competitive Bidding Program Issues

From the Desk of Mark Higley

Many DMEPOS stakeholders, including VGM, have been actively monitoring this rule as it was titled Medicare Program; End-Stage Renal Disease Prospective Payment System, Payment for Renal Dialysis Services Furnished to Individuals With Acute Kidney Injury, End-Stage Renal Disease Quality Incentive Program, Durable Medical Equipment, Prosthetics, Orthotics and Supplies (DMEPOS) Fee Schedule Amounts, DMEPOS Competitive Bidding Program (CBP) Amendments, Standard Elements for a DMEPOS Order, and Master List of DMEPOS Items Potentially Subject to a Face-to-Face Encounter and Written Order Prior to Delivery and/or Prior Authorization Requirements.

More specifically, there was some speculation that the arguably late release from OMB for publishing in the Federal Register might have suggested some possibility of a Round 2021 competitive bidding program update. Perhaps a change in the effective date or product categories eligible for inclusion, but these were not to occur. 

As we noted in yesterday’s update, the majority of the rule (other than the ESRD issues) finalized the 2019 proposals relative to gap filling, new HCPC codes, the face to face/written order and prior authorization issues. 

As far as the competitive bidding program is concerned, the rule set forth new change of ownership (CHOW) requirements applicable to a bidding products, in addition to an agency update applicable to the relatively few (6) comments from suppliers, industry representative groups, and others in response to their Comment Solicitation on Sources of Market-Based Data Measuring Sales of Diabetic Testing Strips to Medicare Beneficiaries. “We will consider these comments carefully as we contemplate future policies,” noted CMS. 

A DMEPOS-only summary of the final rule may be accessed here. To access the entire rule in the Federal Register, go to https://www.govinfo.gov/content/pkg/FR-2019-11-08/pdf/2019-24063.pdf. Note the Rule is 162 pages in length, with the majority applying to ESRD. The page key for DMEPOS issues is as follows:

  • Gap Period – 82-92
  • New HCPC Codes – 92-95
  • Face to Face – 95-104
  • Prior Authorization/Written Order – 104-130
  • CHOW – 130-131
  • Diabetic Test Strips – 138-140
  • Summary Pages – 141-142, 159-160, 162

We will continue to monitor all issues relative to the 2021 program. Questions? Email me at [email protected] or call/text at 319.504.9515.

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