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WASHINGTON – Industry stakeholders will keep an eye on CMS as it takes next steps toward a new round of competitive bidding and will act to preserve current guardrails for the program, they say.
CMS on May 25 announced a temporary gap period in the program starting Jan. 1, 2024. Contracts for off-the-shelf back and knee braces for the current round, Round 2021, expire on Dec. 31, 2023.
“It takes 18 months or more to get the bid program up and running and go through all the processes, so I think they kind of had to go on record with a temporary gap period,” said Tom Ryan, president and CEO of AAHomecare. “We need to make sure they are not going to take away some of the guardrails, like the clearing price methodology and using the unadjusted fee schedule as the bid ceiling. If we have to get legislation to codify (those guardrails), we will.”
Before starting bidding for the next round of the program, CMS says it needs to go through a formal public notice and comment rulemaking process, something Ryan doesn’t expect to happen until 2024.
CMS also says it needs to “implement necessary changes” to the program to establish sustainable pricesand create savings for Medicare beneficiaries and taxpayers. Considering 13 product categories were eliminated from Round 2021 due to lack of savings, that’s a tall order, says Ryan.
“If they didn’t see savings for the last round, pre-pandemic when those rates were bid, you’re certainly not going to see it now,” he said. “If, in fact, there is an increase in the pricing that shows the cost of goods and the cost of services are higher than the last round of bid prices, then that should be the case. It needs to be a two-way street. But we haven’t fleshed it all out yet.”
Meanwhile, work continues to secure reimbursement relief through S. 1294,which would extend the 75/25 blended Medicare reimbursement rate for suppliers in non-rural, non-competitive bidding areas through the end of 2024.AAHomecare is ramping up grassroots efforts to build support for that bill, as well as to get a companion bill in the House of Representatives.
"We’re creating an industry support letter,” said Jay Witter, senior vice president of public policy for AAHomecare. “It’s helpful for the Senate folks to have the state associations endorse. We’re also working on a Dear Colleague letter from Sens. Thune and Stabenow.”