Competitive Bidding Resource Center
Welcome to the NHIA member resource center on Medicare competitive bidding.
The Medicare Prescription Drug, Improvement and Modernization Act of 2003 (MMA) requires establishing a competitive bidding program for certain DMEPOS products and services furnished to Medicare beneficiaries under Part B. The Medicare Improvement for Patients and Providers Act of 2008 (MIPPA) amended and added to MMA provisions, including requiring termination of the competitively bid supplier contracts that the Centers for Medicare & Medicaid Services (CMS) had entered into for "Round 1" of the program. MIPPA also required an overall delay of the program and included a number of provisions intended to fix problems that became visible in the now-postponed roll out of Round 1. On January 15, 2009, CMS announced the resumption of the program with issuance of an interim final rule which went into effect on April 18, 2009 that incorporates the MIPPA requirements. CMS opened re-bidding for Round 1 on October 21, 2009 which closed on December 21, 2009. There was a prolonged period after bidding which led to implementation of Round 1 on January 1, 2011.
In January of 2008, CMS announced its plans to include 70 Metropolitan Statistical Areas (MSAs) for Round 2. The Affordable Care Act of 2010 (ACA) required an additional 21 MSAs for a total of 91 MSAs. In August of 2011, CMS announced the MSAs, the product categories and a time line for Round 2 which calls for bidding to begin in Winter of 2012. In April of 2012, CMS announced plans to recompete Round 1 given expiration of the Round 1 contracts on December 31, 2013.
Therapies of Primary Interest to NHIA Members. While it is unfortunate that enteral nutrition therapy is included in the first and second rounds of competitive bidding, it is most important to note that CMS had paid attention to NHIA’s arguments as to why selection of infusion drug therapies would not be appropriate. Of the top ten products CMS had identified for inclusion in Round 1 in terms of Part B expenditures, the final selected product set comprised all of the top ten except that infusion drugs and pumps (and lower limb Orthotics) were excluded. Infusion drug therapies were also excluded in Round 2 of the program. We note that Congress considered NHIA arguments when it excluded total parenteral nutrition from competitive bidding in the MMA.
Inclusion of Infusion Drug Therapies. NHIA is extremely disappointed that CMS announced inclusion of external infusion pumps and supplies in the Round 1 recompete. The surest way to stop this from happening is to get Medicare legislation passed for a meaningful Medicare benefit for home infusion therapy. Help out now!
As a result of the CURES Legislation passed in late 2016 DME Infused Drug payments are set based on ASP+6% and are excluded from Competitive Bidding.
Round 2019 includes Enteral Therapy, but does not include external infusion pumps, with the exception of insulin pumps.
Quality Standards/Accreditation. Most Part B DMEPOS suppliers must have been accredited for DMEPOS by October 1, 2009. This requirement is independent of any developments with or participation in the competitive bidding program. Learn more at NHIA's Medicare Accreditation Resource Center.
Surety Bond Round 2019 will requires bidder to have a $50,000 surety bond in place. This is completely separate from the standard DME supplier surety bond.
Tools and Resources