Statement on Competitive Bidding July 2008

Beginning July 1, 2008, the Centers for Medicare and Medicaid Services (CMS) rolled out a new—and potentially devastating—competitive bidding process for purchasing Durable Medical Equipment, Prosthetics, Orthotics, and Supplies (DMEPOS) that many people with disabilities of all ages literally rely on for their lives. This new program initially started with 10 competitive bidding areas.

The program establishes rates for certain categories of equipment and supplies. CMS says the program seeks to reduce costs and prevent fraud/abuse to Medicare, and will save consumers money by requiring all vendors in target areas to meet CMS’s eligibility, quality and financial standards. NCIL is concerned that the savings that the Administration states will occur under the competitive bidding program will actually result in increased costs due to extended hospital stays and additional visits to physician offices.

NCIL has been proactive in getting information on the program and its affects on members in the affected regions.  We have significant concerns about both the design and implementation of the DMEPOS program proposed by CMS.

Since the program has been implemented less than two weeks ago, there have been disturbing reports of quality and access to care issues.  It is our belief that these issues cannot be resolved under this operational framework.  Thus NCIL believes that a delay is warranted so that critical improvements can be made.

NCIL’s concerns include:

• A reduction of the number of “approved” suppliers will likely result in a reduction of supplier choices for consumers and a longer waiting period for equipment and repairs.
  
• A reduction in the number of suppliers means consumers may have to travel long distances to obtain or repair their equipment.
  
  
• An arbitrary certification process now jeopardizes lifelong relationships consumers have with their suppliers and technicians familiar with their specific needs.
  
  
• Consumers may face changes in acquiring the brand, options, and flexibility of equipment and supplies they have become familiar with.
  
  
• Before competitive bidding, consumers may have obtained all necessary services from a single supplier; under competitive bidding consumers may now be forced to visit several suppliers in order to meet their needs.
  
  
• Cost effectiveness must not supercede the right of consumers to have highly complex and customized equipment that is the most appropriate and effective to meet their individual life needs.
  
  
• Medicaid programs and private insurance may follow the example of Medicare’s competitive bidding
  program that would result in consumer difficulties across the nation.

Letter to Representative Allen on Competitive Bidding

The Honorable Tom Allen
United States House of Representative
1127 Longworth House Office Building
Washington, D.C. 20515

November 9, 2007

Dear Representative Allen:

The National Council on Independent Living writes in support of H.R. 2231 “Medicare Access to Complex Rehabilitation and Assistive Technology Act of 2007”.

The National Council on Independent Living (NCIL) is the oldest cross disability, grassroots organization run by and for people with disabilities. Founded in 1982, NCIL represents over 700 organizations and individuals including: Centers for Independent Living (CILs), Statewide Independent Living Councils (SILCs), individuals with disabilities, and other organizations that advocate for the human and civil rights of people with disabilities throughout the United States.

NCIL is concerned that changes in Medicare coverage and reimbursement policies, such as Medicare’s competitive acquisition program, may inappropriately restrict consumer access to the quality health care that the Medicare program was created to deliver.  We are particularly concerned with how this new program may impact the availability of the highly customized, complex power wheelchairs, which people with disabilities desperately need to complete the daily activities that most of us take for granted. 

The “Medicare Access to Complex Rehabilitation and Assistive Technology Act of 2007” will exempt complex rehabilitation products and assistive technology products from Medicare’s competitive acquisition (or bidding) programs. We believe imposing a competitive bidding process on complex rehabilitative services will substantially undercut the quality of life for thousands of persons with disabilities.

Complex rehab technologies are not commodity products that are easily interchangeable.  Each consumer of complex rehab technology has individual and specialized needs that require extensive customization.

Competitive bidding fails to allow for the level of services and significant costs associated with the delivery of complex rehab technology to people with disabilities.
Properly fitted equipment has a significant role not only in providing consumers with their greatest level of independence, but also in preventing or delaying related medical complications or secondary conditions which can increase health care costs significantly.

Many people with disabilities may be forced to obtain wheelchairs from providers who do not have the experience or expertise that is needed to meet complex needs. For those in rural areas, a supplier experienced with the needs of people with disabilities may not be available and those that are available may not be able to provide the level of service that is desperately needed, such as follow-ups.

Significant savings will not be achieved by including complex rehab technology in competitive bidding.  CMS has acknowledged that the complex rehab product category is “small”.  Data released by CMS demonstrates that utilization of complex rehab products is low.  An industry commissioned study estimates the cost of the exemption over the first five years of the CB program to be $46 million.

While we applaud Congress and the Centers for Medicare and Medicaid Services for working to reduce cost and combat fraud and abuse, these efforts must not be accomplished at the expense of people with disabilities.

NCIL advances independent living and the rights of people with disabilities through consumer-driven advocacy.  NCIL envisions a world in which people with disabilities are valued equally and participate fully. For these reason, NCIL strongly support H.R. 2231, as it will preserve access to technologies people with disabilities must have in order to live independently in their homes and communities.

Sincerely,                                                       

Kelly Buckland                                    John A. Lancaster