Changes Coming Jan 1 to DMEPOS Program:
What Medicare-Enrolled Providers, Physicians, Treating Practitioners, Discharge Planners, Social Workers, and Pharmacists Need to Know
Medicare is phasing in a new program that changes the amount Medicare pays for certain durable medical equipment, prosthetics, orthotics, and supplies (DMEPOS) and requires Medicare contract suppliers to furnish these items in most cases. Health care providers play a key role in helping their patients understand how they will be affected by this change and what they need to do in order to continue to have Medicare pay for the high-quality equipment and supplies they need.
Starting January 1, 2011, if your patients with Original Medicare live in or visit one of the communities listed below, and must obtain any of the equipment or supplies included in the program (also listed below), they will almost always have to use Medicare contract suppliers for Medicare to help pay for the item.
The first nine areas included in the new program are:
- Charlotte - Gastonia-Concord, NC - SC
- Cincinnati - Middletown, Ohio - Kentucky - Indiana
- Cleveland - Elyria - Mentor, Ohio
- Dallas - Fort Worth - Arlington, Texas
- Kansas City, Missouri - Kansas
- Miami - Fort Lauderdale - Pompano Beach, Florida
- Orlando - Kissimmee, Florida
- Pittsburgh, Pennsylvania
- Riverside - San Bernardino - Ontario, California
The products and equipment included in the program are:
- Oxygen, oxygen equipment, and supplies
- Standard power wheelchairs, scooters, and related accessories
- Complex rehabilitative power wheelchairs and related accessories (Group 2 only)
- Mail-order diabetic supplies
- Enteral nutrients, equipment, and supplies
- Continuous positive airway pressure (CPAP) devices and respiratory assist devices (RADs) and related supplies and accessories
- Hospital beds and related accessories
- Walkers and related accessories
- Support surfaces (Group 2 mattresses and overlays in Miami-Fort Lauderdale-Pompano Beach only)
If your patients currently rent oxygen and oxygen equipment or durable medical equipment, they may be able to continue renting these items from their current supplier when the program takes effect, if the supplier decides to participate in the program as a “grandfathered” supplier.
Medicare has a variety of resources available to help you understand the new program at www.cms.gov/DMEPOSCompetitiveBid; DMEPOS Competitive Bidding Program Medicare Learning Network® (MLN) Fact Sheets can be found at www.cms.gov/MLNProducts/downloads/DMEPOS_Competitive_Bidding_Factsheets.pdf.