The Medicare Competitive Bidding Program was created to lower Medicare spending on
selected medical equipment and supplies by forcing suppliers to compete for limited
contracts in designated areas. The United Ostomy Association of America (UOAA)
states that the Centers for Medicare and Medicaid Services (CMS) plan to award
contracts to suppliers who bid for the lowest and most competitive price. Medicare Part B covers
Durable Medical Equipment, Prosthetics, Orthotics, and Supplies (DMEPOS).
The Local Coverage Determination Ostomy Supply Policy A52487, states ostomy supplies are
covered under the Prosthetic Device benefit (Social Security Act Section 1861(s)(8)).
Under the Social Security Act, ostomy and urological supplies are rightly categorized and
defined as prosthetic devices (§1861(s)(8)) as they are restoring the lost organ functions
of biological waste storage and elimination - and as such, were specifically excluded
from the CBP (competitive bidding program) by Congress under §1847(a)(2)(A).
Medicare plans to restart a flawed program called "Competitive Bidding" that sets rates for
Home Medical Equipment (HME) & supplies by awarding a few contracts to HME suppliers
who bid the lowest - regardless of the true costs of providing quality care.
According to the American Association for Home Care (AAHC), 75% of suppliers were
excluded from being able to provide care for end users & resulted in 37% of HME locations
closing across the country, leaving end users with fewer choices, longer wait times, or
no access for supplies at all. Medicare paused this program due to problems but now plans
to restart this program. Because many Medicaid programs & other insurers follow Medicare's lead,
this could affect anyone who needs home medical equipment nationwide.
Medicare proposes awarding contracts to only 8 companies nationwide to provide ostomy supplies
under a remote delivery model. The American Association for Home Care (AAHC) relates
that ostomy products are highly individualized & require expert knowledge and ongoing
support and product adjustment to ensure proper fitness and product selection in order
to maintain skin health, mobility, & dignity.
The new program could put ostomates at risk of product mismatches, poor outcomes,
& reduced independence. Furthermore, Medicare does not have the statutory authority
to include ostomy supplies in the CBP (competitive bidding program) since these
products were initially covered under its prosthetic device benefit.
The United Ostomy Association of America (UOAA) relates that ostomy/urological
supplies are clinically prescribed and not one-size-fits-all as a precise fit
is crucial to prevent leaks, odor, and severe skin complications.
The UOAA believes that this proposal could seriously influence your quality of life.
What if you only have access to one product, or one brand, or the products that you use
aren't sold by the suppliers who win the bid? The final rule would restrict you to a
limited number of suppliers which could lead to reduced access to care, lower the
quality of products jeopardizing your ability to effectively manage your ostomy,
limit your freedom of choice, and may override your healthcare professional's
prescribed treatment plan which could disrupt your care.