CMS Prepares to Expand NCB Pricing to New Regions

Portions of the country not currently affected by Medicare's national competitive bidding program are now in the crosshairs of the Centers for Medicare & Medicaid Services (CMS).

A July 2 proposed rule detailed how CMS plans to use competitive bidding information to "adjust the fee schedule amounts for DME in areas where competitive bidding programs are not implemented."

The proposed rule includes the following provisions:

-- Adjust fee schedule amounts for states in different regions of the country based on competitive bidding pricing from competitions in these regions. The regional prices would be limited by a national ceiling (110 percent of the average of regional prices) and floor (90 percent of the average of regional prices).

-- Use national ceiling as adjusted fee for states that are predominantly rural or sparsely populated (aka, "frontier states").

-- Adjust fee schedule amounts for non-contiguous areas based on the average of competitive bidding pricing from these areas or the national ceiling, whichever is higher.

The proposed rule also includes a change to current ownership and competitive bidding contract policies. Currently, suppliers who win contracts are not allowed to sell them to other parties.

Under the new policy, the proposed rule says, "CMS may permit the transfer of a contract to an entity that merges with or acquires a competitive bidding contract supplier if the new owner assumes all rights, obligations, and liabilities of the competitive bidding contract. This proposed rule would establish an exception to the prohibition against subdividing a contract that would allow a contract supplier to sell a distinct company (e.g., an affiliate or subsidiary) which furnishes a specific product category or a specific competitive bidding area."

In a July 3 bulletin to stakeholders, NCART Executive Director Don Clayback noted of the proposed rule, "The proposed changes include some that will have significant negative implications to access and payment of DME in general, including wheelchairs, accessories and related repairs."

The proposed rule appeared in the July 11 edition of the Federal Register. CMS is accepting comments until Sept. 2, 2014.

About the Author

Laurie Watanabe is the editor of Mobility Management. She can be reached at lwatanabe@1105media.com.

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