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Medicare Competitive Bidding

To date, the Trump Administration has not continued to pursue the expansion of the CB program. It would take new legislation from Congress in order to include urologic and ostomy in the CB program. The WOCN Society has created an evidence-based policy paper which focuses on the impact of competitive bidding and access to care and supplies that will be ready for use if the program does move forward. WOCN staff met with CMS Principal Deputy Administrator, Demetrios Kouzoukas, late last year to express our concerns with including ostomy products in the CB program. The meeting was organized by the Access & Care Coalition (ACC), of which WOCN is a member.

Mr. Kouzoukas offered the following observations:

  1. He thanked us for providing the overview and information regarding the current status of product availability through the Medicare Program;

  2. He described the steps CMS is taking to address the identified shortcomings in the Competitive Bidding Program, including the suspension of the Program and the ongoing redesign/restructuring at CMS;

  3. He stated that there will be a gap period (January 1, 2019 through December 31, 2020) where competitive bidding will be suspended and any DMEPOS supplier may provide products and services to beneficiaries;

  4. He stated that CMS had just announced an additional three product categories it plans to include in the restructured Program (ventilators; off-the-shelf back braces; off-the-shelf knee braces) and that ostomy and urological products are not included;

  5. When asked how those categories were identified by CMS, he suggested that those categories were likely to produce greater savings than other categories of products (and, although he did not explicitly say so, it is likely that CMS believes there is abuse by some suppliers in these categories which tracks with the MedPAC June Report to Congress);

  6. He would not specifically state that ostomy and urological products would never be considered for inclusion in the Program;

  7. However, since the lead time necessary to include product categories in the CBP is substantial, he thought it would be very difficult for any additional product categories to be included for the restructured bid round beginning on January 1, 2021.

In summary, the Society will continue to monitor the CBP, but it does not appear imminent that ostomy or urological products will be included in the program in the near future.

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