The Centers for Medicare & Medicaid Services (CMS) will be implementing a new program, effective January 1, 2011, that will change how Medicare beneficiaries and their referral sources can obtain medical equipment. Presently, Medicare original (fee-for-service) beneficiaries and referral sources are allowed to choose a medical equipment supplier of their choice. The new program called "competitive bidding" will reduce the choices for beneficiaries and referral sources. Although the program is primarily for original (feefor-service) Medicare beneficiaries, the regulations may also affect some Medicare health plans.

The CMS has contracted with a limited number of medical equipment suppliers in nine competitive bid areas (CBAs) across the United States. Medicare beneficiaries living in those 9 CBAs will be required to use a medical equipment company from the approved list of contracted suppliers to receive certain pieces of medical equipment. The list of the products and the nine areas affected are below:

The products included in the competitive bidding program

* Oxygen equipment & supplies

* Standard power wheelchairs, scooters, and related accessories

* Complex rehabilitative power wheelchairs and related accessories (certain products)

* Mail-order replacement diabetic supplies mail order only

* Enteral nutrients, equipment, and supplies

* CPAP, RADS, and related supplies and accessories

* Hospital beds and related accessories

* Walkers and related accessories

* Support surfaces (Group 2 mattresses and overlays) in Miami only

The nine CBAs starting January 1, 2011, are as follows:

* Cincinnati-Middletown (Ohio, Kentucky, and Indiana)

* Cleveland-Elyria-Mentor (Ohio)

* Charlotte-Gastonia-Concord (North Carolina and South Carolina)

* Dallas-Fort Worth-Arlington (Texas)

* Kansas City (Missouri and Kansas)

* Miami-Fort Lauderdale-Pompano Beach (Florida)

* Orlando (Florida)

* Pittsburgh (Pennsylvania)

* Riverside-San Bernardino-Ontario (California)

The complete county listing for all nine CBAs can be found at http://www.medicaresuppliersnetwork.com.

How will this affect referral sources and Medicare beneficiaries?

This will affect you, the case management referral source, and your Medicare beneficiary in numerous ways:

1. If a patient needs one of the products listed earlier and resides in one of the CBAs, they are required to get the products from a Medicare-contracted supplier for that area.

2. If a patient currently uses one of the products mentioned earlier, and the patient resides in one of the CBAs listed earlier, they may be required to change providers to a Medicare-contracted supplier. Certain providers will be "grandfathered" into the program. (Some exceptions are allowed; see http://www.medicaresuppliersnetwork.com for the list of exceptions.)

3. If a patient resides in one of the CBAs listed earlier, they may only continue using their preferred medical equipment supplier if the supplier won the product category for that CBA.

4. You may be required to use multiple suppliers for different products to fulfill your patient's needs.

To make sure that medical products and services will be covered by Medicare, you will need to find out which suppliers are Medicare-contracted suppliers. You can find out if a supplier is included in the program by visiting http://www.medicare.gov or by calling 1-800MEDICARE. The list includes the name and contact information for the medical equipment companies that are contracted for each CBA and each product category.

In November 2010, Medicare mailed information to all beneficiaries who live in one of the nine CBAs. Approximately 3.9 million beneficiaries got a letter and brochure about the DMEPOS competitive bidding program. You can review the letters, introductory brochure, and other program education materials by visiting http://www.cms.gov/Partnerships/03_ DMEPOS_Toolkit.asp.

This sounds confusing and you may have a lot of questions about the program and how it will affect you or your patients. A Web site has been created to help educate both the Medicare beneficiary and all referral sources. This Web site is educational only. http://www.medicaresuppliersnetwork. com will answer any questions you may have. We will also be providing additional information as soon as it is released by the CMS. You may also e-mail us at [email protected] to answer any questions you may have.

Note. The competitive bidding program applies only to Medicare patients residing in the nine areas that are in need or are using the products listed earlier and begins January 1, 2011. If your patient resides outside the nine areas listed earlier or they are not on Medicare, then the process for obtaining medical equipment remains the same as today.

Wayne Grau was a formative member of Pride Mobility's team, and in 2007, Wayne left Pride Mobility Products to work on a Congressional campaign. After the election, Wayne accepted a position with The MED Group as Sales Team Leader. He is currently the Vice President of Contracting and Business Solutions.