Medicare Rights Comments on Proposed Changes to Medicare’s DME Program

This week, the Medicare Rights Center submitted comments in response to a proposal from the Centers for Medicare & Medicaid Services (CMS) that would, in part, make major changes to the Durable Medical Equipment, Prosthetics, Orthotics, and Supplies (DMEPOS) Competitive Bidding Program.

Through the DMEPOS bidding program, medical equipment suppliers compete for Medicare’s business based on quality and price, by submitting bids to serve beneficiaries in a specified geographical region. In the proposed rule, CMS is seeking to effectively suspend this program when current contracts expire at the end of 2018. The program would be suspended until new contracts are awarded under the outlined new payment methodology, however, CMS does not provide a time frame for when new contracts would begin.

We are deeply concerned about this strategy. Abruptly cancelling the existing program would create a void that must be filled by interim payment policies. This stopgap approach is likely to cause significant beneficiary and supplier confusion, and create lapses in important beneficiary protections.

Under the “temporary” payment methodology—which would begin January 1, 2019 and last for an undetermined period of time—beneficiaries who have come to rely on the availability of their equipment, orthotics, and supplies for a fair, market-set price would again be forced to extensively comparison shop. That puts them again at risk of overpaying and of facing extreme out-of-pocket costs—problems the DMEPOS program alleviated. All parties would need to be educated about this impermanent “new normal.”

This level of disruption may be warranted if the program were failing dramatically. That is not, however, the case. While in the draft rule CMS seeks to justify its plan by citing undue barriers to access within the current program, available evidence reflects the contrary. Recent reports from the nonpartisan Government Accountability Office (GAO) indicate the bidding program has not negatively affected beneficiary access or satisfaction, and trends heard on our national helpline support those findings.

This is not to say that changes or alterations to the program are not warranted. However, the proposed rule is too extreme; its disruption outweighs the program’s modest problems and considerable benefits. Accordingly, we urge CMS to revisit its approach and immediately open bidding for service provision under the current program for the 2019 plan year. If CMS wishes to establish a new methodology for later plan years, we ask that it do so in a way that preserves beneficiary protections and the status quo, and allows time for a smooth transition.

Medicare Rights continues to strongly support the DMEPOS Competitive Bidding Program, and its role in advancing how Medicare pays for medical equipment and services. We look forward to working with stakeholders and policymakers to ensure the program remains well-positioned to best meet the needs of people with Medicare and their families.

Read our comments on the DMEPOS Competitive Bidding Program.

Read our National Helpline Trends report.