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CMS Durable Medical Equipment Alert
Your members
need to know that Medicare is changing the way it pays for
certain durable medical equipment, prosthetics, orthotics and
supplies, also known as DMEPOS; what it pays for these items,
and who may supply them. These items include for example,
hospital beds, diabetic supplies, power wheelchairs and walkers.
The new program will begin July 1, 2008 in 10 communities around
the country, including Charlotte-Gastonia-Concord, NC-SC;
Cincinnati-Middletown, OH-KY-IN; Cleveland-Elyria-Mentor, OH;
Dallas-Fort Worth-Arlington, TX; Kansas City, MO-KS; Miami-Fort
Lauderdale-Miami Beach, FL; Orlando-Kissimmee, FL; Pittsburgh,
PA; Riverside-San Bernardino-Ontario, CA; San
Juan-Caguas-Guaynabo, PR.
This change will affect ALL Medicare beneficiaries who need to
purchase certain equipment and supplies, and will mean that many
Medicare beneficiaries will need to change the suppliers they
use for these items if Medicare is to cover them.
Basic background information:
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This
change is the result of the implementation of the Medicare
DMEPOS Competitive Bidding Program, which was mandated by
Congress as part of the Medicare Modernization Act, the same
Act that brought us the Medicare Prescription Drug Program.
Once the new program is in place across the country, it is
expected to save Medicare and taxpayers about $1 billion
each year.
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By using
competition across suppliers, Medicare will pay a lower
price that is more in line with current market prices for
these items. That also means that beneficiaries, who pay a
20% co-pay for equipment and supplies, will also save money.
Please share
this information with your members:
Information You Need: New Medicare-covered Equipment and
Supplies Program In Certain Designated Areas
If you order, refer or supply certain medical equipment and
supplies, such as oxygen or power wheelchairs, you should know
about a new Medicare program that may change the suppliers your
patients will need to use.
The new program will begin July 1, 2008 in 10 geographic areas
around the country, including Charlotte-Gastonia-Concord, NC-SC;
Cincinnati-Middletown, OH-KY-IN; Cleveland-Elyria-Mentor, OH;
Dallas-Fort Worth-Arlington, TX; Kansas City, MO-KS; Miami-Fort
Lauderdale-Miami Beach, FL; Orlando-Kissimmee, FL; Pittsburgh,
PA; Riverside-San Bernardino-Ontario, CA; San
Juan-Caguas-Guaynabo, PR. The program will expand to 70
additional areas in 2009 and to additional areas thereafter.
If your patient lives in or travels to one of these 10
designated areas and you order, refer or supply any medical
equipment or supplies that fall within the 10 product categories
listed below, the patient must now get the equipment or supplies
from a Medicare-contracted supplier.
The 10 product categories that are included in the program are:
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Oxygen
supplies and equipment;*
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Standard
power wheelchairs, scooters and related accessories;
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Complex
rehabilitative power wheelchairs and related accessories;*
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Mail-order
diabetic supplies;
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Enteral
nutrients, equipment, and supplies;*
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Continuous
Positive Airway Pressure (CPAP) devices and Respiratory
Assist Devices (RADs) and related supplies;
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Hospital
beds and related accessories;*
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Negative
pressure wound therapy pumps and related supplies and
accessories;
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Walkers
and related accessories; and
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Support
surfaces, including group 2 mattresses and overlays (in
Miami-Fort Lauderdale-Miami Beach, FL only).*
(* Indicates
product category is NOT included in San Juan-Caguas-Guaynabo,
PR)
To ensure that his or her medical products and services will be
covered by Medicare, we encourage you to help your patient find
out which suppliers are Medicare contract suppliers. After the
suppliers are announced in May, you can find out if a supplier
is included in the program by visiting
http://www.cms.hhs.gov/CompetitiveAcqforDMEPOS .
For the latest provider information on this new program, CMS has
released 3 MLN Matters educational articles, which can be found
at:
http://www.cms.hhs.gov/MLNMattersArticles/downloads/SE0805.pdf
http://www.cms.hhs.gov/MLNMattersArticles/downloads/SE0806.pdf
http://www.cms.hhs.gov/MLNMattersArticles/downloads/SE0807.pdf
Once again, if your patient lives in or travels to one of the 10
designated areas and you order, refer or supply any medical
equipment or supplies that fall within the 10 product
categories, please discuss the new program requirements with
your patient, and provide them with the Medicare fact sheet
entitled "What You Should Know if You Need Medicare-covered
Equipment or Supplies."
http://www.medicare.gov/Publications/Pubs/pdf/11307.pdf
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