On the heels of an announcement last week that Tennessee providers of durable medical equipment (DME) are skirting the Centers for Medicare & Medicaid Services (CMS) Competitive Bidding rules, such non-compliance appears to be a nationally widespread issue.
Medicare mandates that DME providers who have submitted bids for Round 2 of the bid program are required to have all licenses and accreditation in place no later than May 1, 2012, however, state regulatory data released at a recent Washington Legislative Conference revealed not everybody is playing by the rules.
About 52% of contracted DME suppliers in Washington, Baltimore and Philadelphia bid areas do not have the required license to provide their services in the state of Maryland, reports HME Business.
More than half of South Carolina providers holding contracts do not posses the required licenses or permits to compete in Round 2.
Additionally, more than 90 contracts for Ohio were signed by companies not qualified to provide such services to beneficiaries living in the state.
Although CMS’s official rules state that providers will be disqualified from competing in Round 2 if they do not have the necessary licenses or permits as of the original May 1, 2013 deadline, CMS has extended the deadline to July 1.
With only a month until then, the deadline extension leaves many providers little time to obtain the proper certifications.
Obtaining the correct licensing, accreditation and permits are only part of the problem, as many DME providers are holding contracts for areas in which they are hundreds, even thousands, of miles away from the patients they are supposed to serve.
For example, 74% of providers winning contracts for Hawaii were on the mainland, more than 2,500 miles away. More than 50% of New York’s winning providers are located outside of the state, with an average distance for those out-of-state providers being 600 miles away.
Such difficulties and issues of non-compliance have urged lawmakers to push for a bill, H.R. 1717, that would replace the Competitive Bidding program with a market pricing program.
Written by Jason Oliva