Washington, DC: Today the Council for Quality Respiratory Care commends the Centers for Medicare & Medicaid Services (CMS) for announcing in a proposed rule that it will not award competitive bidding contracts to 13 durable medical equipment (DME) product categories including oxygen and oxygen supplies in 2021. While CMS has not formally delayed Round 2021 of the competitive bidding program (CBP), the exclusion of oxygen supplies and services represents a victory for stakeholders who warned that the inclusion of home respiratory care product categories in Round 2021 could threaten vulnerable patients’ access to this critical care – an especially prescient concern during the ongoing COVID-19 public health emergency (PHE).
“CMS has heard from a range of stakeholders requesting that the agency delay or cancel the Round 2021 DMEPOS CBP due to the ongoing COVID-19 Public Health Emergency. CMS considered that feedback in moving forward with the Round 2021 DMEPOS CBP. CMS is not awarding competitive bidding contracts for any of the 13 product categories for Round 2021 that were previously competed because the payment amounts did not achieve expected savings,” CMS said in an official announcement.
“We commend CMS for listening to the concerns of home respiratory care providers and patient advocates who warned that restarting the bidding program for home oxygen supplies and services on January 1, 2021 would destabilize a sector already struggling to manage the challenges of navigating the COVID-19 pandemic,” said Crispin Teufel, Chairman of the CQRC. “By excluding home respiratory care product categories in Round 2021 in the proposed rule, CMS will help ensure continued access to quality respiratory care in the home for vulnerable Medicare beneficiaries.”
In releasing the proposed rule, CMS proposes that the fee schedule amounts for items and services furnished on or after April 1, 2021, or the date immediately following the duration of the PHE, whichever is later, in non-contiguous non-CBAs be adjusted to equal a blend of 50 percent of the greater of the average of the single payment amounts (SPAs) for the item or service for CBAs located in non-contiguous areas or 110 percent of the national average price for the item or service and 50 percent of the unadjusted fee schedule amount for the area.
In addition, CMS proposes that the fee schedule amounts for items and services furnished in rural contiguous areas on or after April 1, 2021 or the date immediately following the duration of the PHE, whichever is later, be adjusted so that they equal a blend of 50 percent of 110 percent of the national average price for the item or service and 50 percent of the fee schedule amount for the area in effect on December 31, 2015, increased for each subsequent year beginning in 2016 by the annual update factors for durable medical equipment and supplies, off-the-shelf orthotics, and enteral nutrients, supplies, and equipment. For items and services furnished on or after April 1, 2021 or the date immediately following the duration of the PHE, whichever is later, in all other non-rural non-CBAs, CMS proposes that the fee schedule amounts be equal to 100 percent of the adjusted payment amount.
In making its announcement, CMS recognized that the average volume of items and services furnished by suppliers is lower in non-CBAs than in competitive bidding areas (CBAs) and noted that the total services per supplier continued to increase in 2018 and 2019 in all non-CBAs. However, CMS data show that many smaller suppliers have exited the market in recent years, fueling consolidation. With the 50/50 blended rate in effect in rural and non-contiguous non-CBAs, CMS said that it does not believe beneficiary access to oxygen and oxygen equipment is in jeopardy.
“By setting the rural rates permanently at the 50-50 blended, CMS wisely recognized the need to maintain the sustainability of suppliers so that patients in these rural and sparsely populated areas can continue to receive uninterrupted access to care,” continued Teufel. “We commend CMS for taking this vital step and ensure vulnerable patients’ continued access to home respiratory care in non-competitive bidding areas.”
