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CONNECT TO | Policy & Legislation
November 2010
 

New Medicare durable medical equipment procedures
Reducing expenses for consumers

Medicare is changing the way beneficiaries in some parts of the country get certain kinds of durable medical equipment, such as wheelchairs and oxygen. The DMEPOS (Durable Medical Equipment, Prosthetics, Orthotics, and Supplies) Competitive Bidding Program is designed to ensure beneficiaries with Original Medicare continue to receive quality medical equipment and related services from accredited suppliers, while reducing beneficiaries' out-of-pocket expenses and saving the Medicare program money.

New Medicare durable medical equipment procedures

Medicare generally pays 80 percent of the fee for equipment and supplies used in the home and beneficiaries pay the remaining 20 percent. The Office of the Inspector General and the Government Accountability Office conducted numerous studies and found that, under the previous arrangement, the prices paid by Medicare for certain items were excessive, sometimes three to four times that of retail prices and the amounts paid by commercial insurers.

Beginning Jan. 1, 2011, Medicare beneficiaries with Original Medicare who live in Cincinnati and Cleveland will begin to see lower out-of-pocket costs and the Centers for Medicare & Medicaid Services (CMS) will be better able to monitor the quality of durable medical equipment and supplies paid for under Medicare. Clients in Medicare Advantage programs are not affected and will continue to get their equipment and supplies from suppliers contracting with their plans.

Medicare beneficiaries with Original Medicare who live in Cincinnati and Cleveland will be affected by this new program if they get:

  • Oxygen, oxygen equipment and supplies;
  • Standard power wheelchairs, scooters and related accessories;
  • Complex rehabilitative power wheelchairs and related accessories;
  • Mail-order diabetic supplies;
  • Enteral nutrients, equipment and supplies;
  • Continuous Positive Airway Pressure (CPAP) devices and Respiratory Assist Devices (RADs) and related supplies and accessories;
  • Hospital beds and related accessories; or
  • Walkers and related accessories.

Beneficiaries who need this equipment or supplies will be limited to specific contract suppliers to obtain what they need. These suppliers have agreed to accept a competitively-bid price from Medicare, and they also have agreed to adhere to CMS-prescribed quality measures.

Certain suppliers who do not win a contract may nonetheless continue to service their Medicare clients if they agree to the same terms and payment rates as the winning bidders. These are called grandfathered suppliers. If beneficiaries are renting equipment that is eligible for grandfathering, the supplier will let them know in writing 30 business days before the program begins.

Some beneficiaries in these areas may need to switch to different suppliers in order to have Medicare continue to cover the equipment and supplies they need. When beneficiaries switch to new suppliers, their doctors will need to write new orders for needed equipment. Current suppliers must pick up their equipment and new suppliers must deliver replacement equipment and supplies to beneficiaries. The pickup and delivery must be coordinated so that nobody is left without needed equipment and supplies.

To find out if the DMEPOS Competitive Bidding Program will affect you, call 1-800-633-4227 or visit www.medicare.gov. "What You Should Know if You Need Medicare-covered Equipment or Supplies", a tip sheet from CMS, describes the program and how it will impact beneficiaries.

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Policy & Legislation

Find available Medicare plans in Ohio
The Centers for Medicare & Medicaid Services (CMS) has released a fact sheet outlining the Medicare health and drug plans available in every state in 2011. According to the fact sheet, in Ohio:

  • 34 Medicare prescription drug plans are available;
  • 100 percent of people with Medicare have access to a Medicare Advantage plan for a $0 premium; and
  • $14.80 is the lowest monthly premium for a prescription drug plan.

Fact sheets examine long-term care
The SCAN Foundation has released six fact sheets compiling national figures on some of the most important issues surrounding long-term care, including demographic and economic characteristics of an aging population, who needs and uses long-term care, where it is provided and who pays for it.