Round 2021 moves forward with OTS Back & Knee Braces, SPAs, and Contract Offers

Due to the ongoing COVID-19 pandemic, stakeholders asked CMS to delay or cancel Round 2021 Durable Medical Equipment, Prosthetics, Orthotics, and Supplies (DMEPOS) Competitive Bidding Program (CBP). CMS had 130 competitive bid areas (CBAs) with over 2,000 competitions. They received over 49,000 bids since Round 2021 began. Unfortunately, the payment amounts did not achieve the savings CMS was expecting for the thirteen categories. Originally, Round 2021 included sixteen product categories in 130 CBAs (non-invasive ventilators were removed in April 2020 due to COVID-19). 

But off-the-shelf (OTS) back and knees brace categories had 127 bids and did show the savings CMS was expecting. Those categories are expected to save $600 million over the three-year contract performance period for the Medicare program and its beneficiaries. The new payment amounts and contracts for OTS back and knee braces will go into effect on January 1, 2021, with the new single payment amounts (SPAs) from CMS. In certain CBAs, some OTS back and knee braces will not be awarded contracts if savings weren’t attained. Payments for those contracts will be based on an adjusted fee schedule amount, in accordance with regulations in CFR 414.210(g).   

While the OTS back and knee brace contracts are moving forward, CMS will continue to evaluate the remaining results of Round 2021 for future changes; with the goal to continue improving the DMEPOS CBP and providing patients with quality items. By helping Medicare establish market-based prices, it will help save the beneficiary’ and taxpayer’s money and limit fraud and abuse cases within the program. 

Moving forward with OTS Back Braces and OTS Knee Braces:

  • Bidders who won contract offers in Connexion (the DMEPOS CBP’s secure portal) need to respond no later than 8:59:59 p.m. prevailing Eastern Time on November 10, 2020.  
  • Bid surety bonds will be collected from the bidders whose bids meet the forfeiture conditions specified in the statute and regulations. 
  • If the bids did not meet the forfeiture conditions in 42 CFR 414.412 (g)(3)(i), their bid surety bond liability will be returned within 90 days of the public announcement of contract suppliers for the CBA. (CMS will notify the bidders and sureties.) 
  • Utilizing the lead item pricing methodology, the SPA for the lead item is the maximum bid amount submitted for that item in the winning range. While the cost for non-lead items will be set by multiplying the lead item SPA using a relative ratio. To learn more about Round 2021 SPAs and how its calculated visit https://dmecompetitivebid.com/spa 
  • Bidders who submitted a complete bid and received a financial score can view that detailed information in Connexion.

Disqualification Notices: 

  • Notices became available on October 27, 2020, in Connexion.
  • Administrative or judicial reviews are not provided in accordance with section 1847(b)(12)(B) of the Social Security Act and 42 CFR § 414.424(a)(2).  
  • Bidders have the opportunity to submit an inquiry for their bid within 30 calendar days from the issue date of the disqualification notice. 
  • Inquiries can be submitted in Connexion for review. 
  • The inquiry deadline is 8:59:59 p.m. prevailing Eastern Time on November 27, 2020.

Competitive bidding surveys will be conducted to learn more about the user’s experiences and satisfaction with the DMEPOS CBP and help CMS determine if any changes need to be made moving forward. Beneficiaries, suppliers, and referral agents (i.e. physicians, social workers, case managers, etc.) will complete the survey. 

As changes continue to go into effect, Medbill is a source of ongoing education to help and inform DME companies with Round 2021 information.  

History on the Medicare DMEPOS CBP

The program was established by the Medicare Prescription Drug, Improvement, and Modernization Act of 2003 (“Medicare Modernization Act” or “MMA”). After being delayed from the Medicare Improvements for Patients and Providers Act of 2008, CMS successfully implemented the Round 1 Rebid in 2011 and in 2013 expanded it to 130 CBAs. In February 2017, Round 2019 would be delayed until 2021 so the SPA methodology could be revised. During that time CMS released information on how it determined beneficiary demand, evaluated how bidder’s roles for CBA and product category combination, and evaluated the financial health for each bidder. 

Resources: 

Financial Scoring Methodology Fact Sheet: https://dmecompetitivebid.com/fs-financialscoringmethodology 

Bidder Inquiry Process Fact Sheet: https://dmecompetitivebid.com/fs-bidderinquiry 

Competitive Bidding Surveys: https://www.cms.gov/medicare/dmepos-competitive-bidding/competitive-bidding-surveys 

Medicare DMEPOS CBP:  http://www.cms.hhs.gov/DMEPOSCompetitiveBid/