C A O. The Medicare DMEPOS Competitive Bidding Program: Update & Activities of the CAO. Competitive Acquisition Ombudsman
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1 C A O The Medicare DMEPOS Competitive Bidding Program: Update & Activities of the CAO Presented by: Tangita Daramola, CAO Hosted by: SMP/SHIP Conference Arlington, VA July 29,
2 Agenda The Durable Medical Equipment, Prosthetics, Orthotics, and Supplies (DMEPOS) Competitive Bidding Program refresher CAO lessons learned Monitoring the Competitive Bidding Program Assisting beneficiaries Stakeholder feedback and discussion 2
3 Role of the Competitive Acquisition Ombudsman The role of the CAO is to serve as a neutral voice in responding to inquiries and complaints from suppliers and individuals regarding the DMEPOS Competitive Bidding Program and the National Mail- Order Program for diabetes testing supplies, while also ensuring that Agency processes respond effectively to complaints about the Programs. 3
4 DMEPOS Competitive Bidding Program Refresher 4
5 What is the Competitive Bidding Program? The DMEPOS Competitive Bidding Program was mandated by Congress through the Medicare Prescription Drug, Improvement, and Modernization Act of 2003 (MMA). Under the program, a competition is conducted among suppliers who operate in a particular competitive bidding area (CBA). Suppliers are required to submit a bid for selected products. o Not all products or items are subject to competitive bidding. 5
6 What is the Competitive Bidding Program? (continued) The supplier competition replaces the outdated fee scheduled for certain items. oas a result, the program: Improves the effectiveness of how Medicare sets payment amounts. Reduces beneficiary out-of-pocket expenses. Ensures access to high-quality products and services. Reduces cost to Medicare. Protects against fraud and abuse. 6
7 Phases of the Competitive Bidding Program 7/2015 1/2011 to 12/2013 Round 1 Rebid /2014 to 12/2016 Round 1 Recompete /2017 to TBD Round /2013 to 6/2016 Round 2 and National Mail-Order Program 7/2016 to 12/2018 Round 2 Recompete and National Mail-Order Program Recompete 7
8 Updates to the Competitive Bidding Program The Program will be implemented in 130 CBAs o 13 Round CBAs o 117 Round 2 Recompete CBAs Elimination of multi-state CBAs Re-organizing product categories and adding new products Fee schedule adjustments in non-cbas 8
9 Fee Schedule Adjustments in Non-Competitive Bidding Areas (CBAs) In January 2016, the Competitive Bidding Program fee schedule will be applied to non-cbas. othere will be an initial 6-month phase-in period. ofees will be based on 50 percent current fee and 50 percent adjusted fee. In June 2016, competitive bidding pricing will apply to suppliers nationwide. opricing will be based on eight regions Regional Single Payment Amount (RSPA). New pricing will be based on averages in the RSPA. Rural areas will be paid at 110 percent of the ceiling. 9
10 Monitoring the Competitive Bidding Program 10
11 Methods of Monitoring Access Process Inquiry and Complaint Process Establishing Relationships and Engaging Partnerships Health and Status Assessment Description A comprehensive beginning-to-end triage process between the CAO and appropriate CMS components to efficiently route, report, and resolve Program inquiries and complaints. Establishing relationships between CMS and the beneficiary, supplier, provider, and advocate communities to better understand the impact of the Program. Maintaining open lines of communication between the parties about stakeholders experiences with the Program. Mechanism CMS uses to collect and evaluate health systems data in order to determine and understand any ancillary effect of changes in programs or implementation of new programs on beneficiary health status. 11
12 Inquiry and Complaint Data Trends Inquiries to the MEDICARE Call Center o July 2014 to June ,549 inquiries 170 complaints were escalated from MEDICARE Inquiries to the Competitive Bidding Implementation Contractor (CBIC) o July 2014 to June ,219 inquiries and complaints from suppliers A majority related to policy and regulations 12
13 Beneficiary Issues Monitored Wheelchair repair access Oxygen access and liquid oxygen exchange Access to external infusion pumps for insulin CPAP documentation issues Discharge planning concerns State licensure changes 13
14 Partner Engagement CMS provides resources and tools for beneficiary education Partners capture feedback from beneficiaries and provide to CMS Partners distribute Program information to beneficiaries 14
15 Importance of the SHIPs The State Health Insurance Assistance Program (SHIP) Directors and Counselors play a key role in helping CMS understand beneficiary issues. Within their respective CBAs, the SHIPs can: o Provide frontline face-to-face assistance to beneficiaries. o Connect beneficiaries to the complaint handling process. o Provide valuable feedback to the CAO through real-time surveillance. 15
16 Assisting Beneficiaries 16
17 Beneficiary Rights and Protections All Medicare DMEPOS suppliers are required to be accredited and meet quality standards. The quality standards include key beneficiary protections and safeguards related to respiratory equipment, power mobility devices (PMDs), and other durable medical equipment (DME). All of these important protections and safeguards will continue to be enforced by independent Accreditation Organizations under the Program. Source: Medicare s DMEPOS Competitive Bidding Program: Supplier Quality Standards and Beneficiary Protections 17
18 Beneficiary Rights and Protections (continued) Beneficiaries are protected under the law and have the right to expect: o Products that are high-quality and meet manufacturers standards. o The correct product needed with proper instructions on how to use it in o language they can understand. o A knowledgeable professional available to respond, repair, or replace existing equipment. Beneficiaries may file a complaint with their supplier or MEDICARE: o Within 5 days, the supplier must confirm with the beneficiary that the supplier received and is investigating the complaint. o Within 14 days, the supplier must send the result and their response in writing to the beneficiary. o If a beneficiary calls MEDICARE and the complaint cannot be resolved by a customer service representative, it will be referred to the appropriate office. Source: Your Guide to Medicare s Durable Medical Equipment, Prosthetics, Orthotics, and Supplies (DMEPOS) Competitive Bidding Program 18
19 How to Effectively Use MEDICARE MEDICARE s purpose is to assist and provide Customer Service. o The customer service representatives (CSRs) ask probing questions based on information provided and scripts available MEDICARE supports 52.3 million Medicare beneficiaries o Addresses ~26 million calls annually o English, Spanish, and TTY Open 24 hours a day, 7 days a week o Mondays and Tuesdays are the busiest days o 10:00 a.m. 4:00 p.m. are the busiest hours 19
20 1-800-MEDICARE (continued) A caller can always ask for an Agent at any time to talk to a CSR. Beneficiaries should expand on the issue or problem when speaking with CSRs at MEDICARE. SHIPs are additional resources for information about the competitive bidding program. 20
21 Filing Complaints on Filing Complaints on Behalf Behalf of Beneficiaries of Beneficiaries Providers and suppliers may file complaints on behalf of beneficiaries. If the beneficiary is not available when the complaint is filed to confirm the provider or supplier is speaking on their behalf, the provider or supplier will need: o Beneficiary s full name, o Date of birth, o HIC number, and o One additional piece of information such as SSN, address, phone number, effective date(s), whether he or she has Part A or Part B coverage. Provider or supplier may elect to file a complaint when the beneficiary is present. Source: Disclosure Desk Reference (DDR) 21
22 Resources (CAO) Website Payment/DMEPOSCompetitiveBid/Competitive_Acquisition_Ombudsman.html Competitive Bidding Program Implementation Contractor (CBIC) Website Medicare Supplier Directory (Supplier Locator Tool) State Health Insurance Assistance Program (SHIP) DMEPOS Competitive Bidding Website Payment/DMEPOSCompetitiveBid/index.html?redirect=/dmeposCompetitiveBid/ DMEPOS Competitive Bidding Program Health Status Monitoring Payment/DMEPOSCompetitiveBid/Monitoring.html Medicare Call Center MEDICARE ( ) TTY DMEPOS Partner Toolkit 22
23 Contact the CAO Tangita Daramola, (CAO) Website: Payment/DMEPOSCompetitiveBid/Competitive_Acquisitio n_ombudsman.html 23
24 Feedback and Discussion 24
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