Medicare Expands Competitive Bidding Program for Durable Medical Equipment


WebconfusionI have been contacted about my CPAP gear. It can be somewhat complicated and may require changing suppliers.

The 2003 law that created the Medicare Part D program also changed the way Medicare pays for certain DMEPOS,( durable medical equipment, prosthetics, orthotics, and supplies.) The payment program did not affect every part of the country or every Medicare beneficiary, however.

Effective July 1, 2013, Medicare beneficiaries in Tennessee as well as other parts of the country saw a change in how they obtain DMEPOS.

The Competitive Bidding Program The Medicare Modernization Act of 2003 (MMA) established requirements for a new Competitive Bidding Program for certain Durable Medical Equipment, Prosthetics, Orthotics, and Supplies (DMEPOS). Under the program, DMEPOS suppliers compete to become Medicare contract suppliers by submitting bids to furnish certain items in competitive bidding areas, and the U.S. Centers for Medicare & Medicaid Services (CMS) awards contracts to enough suppliers to meet beneficiary demand for the bid items.

The new, lower payment amounts resulting from the competition replace the Medicare DMEPOS fee schedule amounts for the bid items in these areas. All contract suppliers must comply with Medicare enrollment rules, be licensed and accredited, and meet financial standards. The program sets what CMS calls more appropriate payment amounts for DMEPOS items while ensuring continued access to quality items and services.

DMEPOS items include wheelchairs, walkers, oxygen and oxygen equipment, hospital beds, and support surfaces (mattresses and the like).

According to Medicare, the Competitive Bidding Program will result in reduced beneficiary out-of-pocket expenses and savings to taxpayers and the Medicare program. That’s because Medicare beneficiaries owe a 20 percent coinsurance payment for DMEPOS. If Medicare pays less, the copayment will be less.

The original competitive bidding program was limited to certain zip codes in 11 states, among them California, Texas, Florida, and Pennsylvania.

The program has been expanded to other states, including certain zip codes in the four major metropolitan areas in Tennessee. Medicare beneficiaries who live in or plan to visit an area that is part of the Competitive Bidding Program generally must use a Medicare contract supplier.

Beneficiaries who are in a Medicare Advantage Plan are not affected by the Competitive Bidding Program. It is applies only to beneficiaries in original Medicare.

FoodPriceInflationWhat should Medicare beneficiaries in Tennessee who need DMEPOS do? It is very likely that they reside in a zip code in which Competitive Bidding Program is now in place. To make sure, beneficiaries should visit www.medicare.gov/supplier and enter their zip code.

For Medicare beneficiaries who are already receiving DMEPOS, they should check with their supplier to see whether their current supplier is under contract with CMS. If not, a supplier can seek to become “grandfathered.” This “grandfathering” includes suppliers who repair equipment that is already owned by the Medicare beneficiary.

If the Medicare beneficiary elects to continue using a non-contract supplier that isn’t grandfathered, the supplier must give the beneficiary an Advance Beneficiary Notice that explains that Medicare won’t pay for the DMEPOS. (Which is not a good outcome for those of us using such products.)

More on www.ElderLawEducation.com

If He Knew He Would Live This Long…….

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A friend recently told me; “If I knew I would live this long I would have taken better care of my body.” I agree with him because of my own experiences. Viet Nam injuries along with a motorcycle wreck while riding … Continue reading

A Subject We Usually Don’t Talk About


Last month I had my right shoulder joint replaced. A serious but a somewhat routine surgery,  except for a complication I faced, I am right handed and additional arthritis prevents me from reaching behind myself with my left arm. Toileting becomes difficult when the only arm I can use is locked in an immobilizer sling tied to my body.UltraSlingII3

I made test trials with various options prior to surgery and was unhappy with the results.  There simply had to be a better, cleaner way. My travels throughout the world proved that there is more than one way to skin a cat….or clean a behind!

Homes and hotels in most countries in Europe, Latin America and Japan have bathrooms equipped with either a bidet, or in Japan, specially equipped toilets and seats.%UseBidetaByCountry

Bidets are hardly used at all in the U.S. while most hotel rooms in Europe had a bidet and commode like this:Bidet and CommodeSome hotel bathrooms even post instructions for use:BidetCorrectUse

My visits to Japan surprised me with the many variations of toilet equipment which allowed cleaning with a water stream and even air drying after a water cleanse, they include electronic controls….. BidetJapanControls

So….I was left with the question; what can I do to retain my dignity and take care of my own toileting? I discussed this problem with an Occupational Therapist. The Occupational Therapist equipped me with two choices, both required I attach toilet paper to a stick to poke between my legs and wipe with a scrubbing motion. Each device held the toilet paper differently but both had a release mechanism to drop the soiled paper into the toilet. The routine was; attach clean paper, scrub, release, attach fresh paper, etc. etc. etc…no better choices were offered.

Toiletaid5Toiletaid1

 

I was not happy with any of these options. Unfortunately there was not enough room to install an additional bidet unit, or time and money enough to buy and have a plumber install a Japanese Deluxe toilet.

Just what could I do?

After a great deal of searching on the internet I found a number of portable products, most attached to the cold water supply to the toilet tank, all had spray attachments suitable for female hygiene use but not good for use for toileting. Finally I found something  that looked like it would do the job….it is called HydraWand.

 

HydrawandToiletPixHydraWandFaucetDiverter

I ordered it, installed it in five minutes. It was a portable device that worked as well as any bidet I used in hotels throughout Europe, Japan, Korea and Hong Kong. The faucet attachment allows me to control the water temperature for total comfort. I will use this even after my arm is out of the sling because it is far superior to toilet paper and every bit as good, if not better, than the bidets found outside the United States.

I sure wish we had something like this in the outhouses we used in Vietnam.BidetOuthouseVietNam