CMS Issues Final Interim Rule on Competitive Bidding
The Centers for Medicare and Medicaid Services (CMS) recently issued a final interim rule regarding the DMEPOS Competitive Bidding program, which will be effective on February 17, 2009. Occupational therapy practitioners should note that OTs in private practice are exempt from bidding for items under the DMEPOS Competitive Bidding program; however, off-the-shelf orthotics are one type of item that will be subject to competitive bidding. This means that if OTs wish to receive Medicare reimbursement for off-the-shelf orthotics in the future, they must be willing to accept the agreed upon reimbursement amount assigned under the program.
Also of note: CMS has yet to provide a definition for “off-the-shelf orthotics” so it remains unclear to AOTA exactly which orthotics assigned to the HCPCS L-codes will be impacted by competitive bidding. Off-the-shelf orthotics will not be part of the Round One re-bid. CMS has not yet issued the lists of products that will be included in Round Two or subsequent bidding. In the interim final rule, CMS reacted to stakeholder concerns about the bidding process (i.e., that there was no process for providing feedback to suppliers regarding missing financial documentation and that contractors did not have to disclose subcontracting relationships to CMS). The rule also reiterates that MIPPA mandated a 9.5% reduction in payment for all items and services that were competitively bid during the round of competition in 2008, regardless of any item exclusion such as Group 3 complex rehab wheelchairs.
The final interim rule can be viewed at the following link: http://edocket.access.gpo.gov/2009/pdf/E9-863.pdf
CMS will accept comments on the rule until March 17, 2009.
*Recent action by the Obama Administration requesting to review and approve any new or pending regulations may change the status of this interim final regulation. Please stay tuned to the AOTA Web site for further information.