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What is the Competitive Bidding Program?
The Competitive Bidding Program requires providers and suppliers of certain durable medical equipment, prosthetics, orthotics, and supplies (DMEPOS) to submit bids to Medicare for their products. Qualified suppliers with winning bids are then chosen as Medicare-approved contract suppliers.
Medicare began Round 1 of the program in January 2011. Respiratory care supplies are a product category included in Round 1.
Under this new program, if you have Original Medicare (Part A and Part B) and live in a competitive bid area (CBA), you may have to use a Medicare contract supplier if you want Medicare to help you pay for your home oxygen equipment or respiratory care supplies. You must also use a Medicare contract supplier if you get these items while temporarily residing in a CBA (for example, while visiting relatives or staying at a vacation home).
What kinds of respiratory items are included in the Competitive Bidding Program?
The following respiratory care items are included in Round 1 of the program:
- Oxygen and oxygen equipment
- Continuous Positive Airway Pressure (CPAP) devices
- Respiratory Assist Devices (RADs)
- Related supplies and accessories (like tubing or a mouthpiece)
How does the program affect me if I use respiratory equipment?
Because the program is being phased in by region, where you live will determine whether and when the program will affect you. If you do not know whether your home ZIP code is within a competitive bid area, you should first use our Competitive Bid Area Search Tool. Then choose from the situations below to find out how the program may affect you.
I do not live in a Round 1 or Round 2 Competitive Bid Area
- You do not have to use a Medicare contract supplier for home oxygen equipment or respiratory care supplies at this time. You may obtain this equipment from any Medicare-approved supplier.
- You may have to use a contract supplier in the future as the program continues to expand to other metropolitan areas.
I live in a Round 1 Competitive Bid Area
- You must use a Medicare contract supplier if you want Medicare to help you pay for your home oxygen equipment or respiratory care supplies.
- If you currently rent or own respiratory care equipment included in the program, you should already be using a Medicare contract supplier.
- If you own your equipment, you can use any Medicare-approved supplier for repairs or replacement parts needed for repair.
I live in a Round 2 Competitive Bid Area
|Do you rent or own your equipment?||Here's what you must do when Round 2 begins on July 1, 2013:|
|I own my equipment.||
|I am still renting my respiratory care equipment.||
|I have been renting my oxygen equipment for at least 36 continuous months.||
What you need to know about "grandfathered" suppliers if you live in a Round 2 Competitive Bid Area
Suppliers that are not Medicare contract suppliers can choose to become "grandfathered" suppliers for certain rented items such as CPAP devices, oxygen, and oxygen supplies. A grandfathered supplier may continue to rent equipment to you if you are using this supplier at the time Round 2 of the program begins in July 2013. Once the rental period for the equipment ends, however, you will need to switch to a contract supplier for replacement supplies and accessories.
For example, suppose you begin renting a CPAP device from a non-contract supplier in February 2013. If you are still renting the equipment from the same supplier in July, and that supplier becomes grandfathered, you can continue using that supplier until your rental period ends.
It's important to know that if you start renting additional equipment from a grandfathered supplier after July 1, 2013, Medicare won't pay for the new equipment. You must use a contract supplier for any new equipment once Round 2 of the program begins.
How will I know if my supplier becomes grandfathered?
If you are renting equipment that is eligible for grandfathering, your supplier must let you know in writing 30 business days before the program begins in your area whether it will or will not become a grandfathered supplier. So if you live in a Round 2 competitive bid area, your supplier will need to send you a letter around the end of May 2013. If you don't hear from your supplier, you should contact them and ask if they are a contract supplier or plan to become a grandfathered supplier.
What if my supplier does not become grandfathered?
A non-contract supplier that does not become grandfathered is required to pick up the item from your home after Round 2 of the program begins. Your supplier must notify you three times before it can pick up the item:
- Your supplier must send you a letter at least 30 days before Round 2 begins telling you that it will no longer provide rental items to you after a certain date.
- Your supplier must call you 10 days before picking up your equipment.
- Your supplier must call you two business days prior to getting the item.
You should keep the pickup slip or other documentation from the supplier to show that you no longer have the item.
If your current supplier does not become grandfathered, you will need to switch to a Medicare contract supplier when Round 2 begins. Your old supplier must work with your new supplier to make sure you have the equipment you need with no break in service.