Medicare EN Competitive Bidding Delayed

On July 15 Congress passed the Medicare Improvements for Patients and Providers Act, overriding a presidential veto and turning H.R. 6331, into law. The bill includes the delay of the Competitive Bidding Program for Home Enteral Nutrition Supplies for 18 months. The act, which goes into effect immediately, also rescinds the more than 10% reduction for physician payments and expands the Medical Nutrition Therapy benefit.

Learn more about this issue on the American Society for Parenteral and Enteral Nutrition (A.S.P.E.N.) web site http://www.clinnutr.org/

Many thanks to A.S.P.E.N. for sharing this good news with Oley members!
 

Original Medicare News on Enteral Competitive Bidding

Medicare Update: EN Competitive Bidding
Who, What, When
Starting July 1, 2008, some enteral consumers who receive Medicare will be affected by the Competitive Bidding Program, mandated by Congress through the Medicare Prescription Drug, Improvement, and Modernization Act of 2003. Under the program, a competition among suppliers who operate in a particular bidding area will be conducted and contracts will be awarded to the suppliers who offer the best price and meet applicable quality and financial standards.

The program applies to people with Original Medicare (not those with a Medicare Advantage Plan) whose permanent residence is in a ZIP code that is part of one of the competitive bidding areas or who are traveling to or visiting one of these areas.

Where
The program will initially take effect in the following ten pilot areas:

  • California — Riverside, San Bernardino, Ontario

  • Florida — Miami, Fort Lauderdale, Miami Beach

  • Florida — Orlando, Kissimmee

  • Missouri and Kansas — Kansas City

  • North and South Carolina — Charlotte, Gastonia, Concord

  • Ohio — Cleveland, Elyria, Mentor

  • Ohio, Kentucky, and Indiana — Cincinnati, Middletown

  • Pennsylvania — Pittsburgh

  • Texas — Dallas-Fort Worth, Arlington

  • Puerto Rico — San Juan, Caguas, Guaynabo

The program will be expanded to include seventy additional areas in July 2009.

What To Do
If you feel the program may affect you, initiate a dialogue with your homecare company or provider. They should be able to advise you whether you will be able to stay with your current supplier and to minimize any challenges or confusion related to delivery or access to care and services.

The Oley Foundation staff and trustees, the American Society for Enteral and Enteral Nutrition (A.S.P.E.N.), and other organizations are committed to helping you understand the process and navigate any issues that you may encounter. Please visit www.oley.org for updates or contact us at (800) 776-6539 for printed material. We have also created a link to A.S.P.E.N.’s Web site, www.nutritioncare.org/news/DMEPOS, which outlines all of the details regarding the program and will host a survey to track obstacles, issues, and concerns on your behalf.
Please do not hesitate to contact us with any questions, issues, concerns and unsettling circumstances related to this process. We’re here to help!


updated 7/28/08