Lawsuits Challenge New DMEPOS Rules

Legal challenges may delay Medicare's efforts to start a competitive bidding for certain durable medical equipment, prosthetics, orthotics, and supplies (DMEPOS).

Centers for Medicare & Medicaid Services (CMS) officials plan to start the program July 1 in the nation's largest 10 metropolitan statistical areas, including the Dallas-Fort Worth-Arlington area. The program would require Medicare patients whose physicians prescribe DMEPOS to obtain the items from a contracted supplier in the area, or they might have to pay for it themselves. This includes common items such as oxygen supplies and equipment, wheelchairs, walkers, mail-order diabetic supplies, and hospital beds.

Plans are to expand it to the Austin-Round Rock, San Antonio, El Paso, Houston-Sugar Land-Baytown, Beaumont-Port Arthur, and McAllen-Edinburg-Mission areas sometime in 2009.

But Modern Healthcare reports that two lawsuits and congressional intervention seek to block CMS from implementing the plan.

Modern Healthcare says the American Association for Homecare contends in a Washington, D.C., lawsuit that CMS "failed to specify the financial standards that were grounds for eliminating providers in the first round of bidding and that the agency arbitrarily downsized its definition of a small provider, a status that confers special treatment under the program."

It said a similar case was filed in a Dallas federal court on behalf of five providers and two consumers.

A third case in Cleveland asks for a preliminary injunction to block the program.

And, Modern Healthcare reported, a letter signed by 40 senators asks Senate leaders to support legislation that would delay the program.

If the program goes forward, CMS urges physicians and other referral agents (i.e., providers who refer Medicare patients for DMEPOS supplies and services) in the competitive bidding areas to be familiar with the requirements of the program. Physicians play a critical role in helping Medicare patients select DMEPOS suppliers that can meet the patient's needs as well as the new DMEPOS requirements.

CMS has developed a Tip Sheet for Referral Agents [ PDF ] to help physicians answer questions their patients may have. It also plans to mail physicians in the Medicare program a comprehensive packet on the program around June 20. The packet will include tip sheets, frequently asked questions, and other relevant documents to assist physicians in helping their patients navigate the DMEPOS program.

Action , June 16, 2008

Last Updated On

June 14, 2010

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