There were changes to Round 1 of the Competitive Bidding Program that started on January 1, 2014. These changes only affect people in areas affected by Round 1 of the Competitive Bidding Program. It’s important to know if you’re affected by these changes to make sure Medicare will help pay for your items and supplies and to avoid any disruption of service.
Do the changes to Round 1 of the Competitive Bidding Program affect my area?
The changes affect Round 1 of the Competitive Bidding Program, which started in January 2011 in certain ZIP codes in these areas:
- Charlotte-Gastonia-Rock Hill (North Carolina and South Carolina)
- Cincinnati-Middletown (Ohio, Kentucky and Indiana)
- Cleveland-Elyria-Mentor (Ohio)
- Dallas-Fort Worth-Arlington (Texas)
- Kansas City (Missouri and Kansas)
- Miami-Fort Lauderdale-Pompano Beach (Florida)
- Orlando-Kissimmee-Sanford (Florida)
- Pittsburgh (Pennsylvania)
- Riverside-San Bernardino-Ontario (California)
How do the Round 1 changes affect my supplier?
The old supplier contracts in the Round 1 areas ended on December 31, 2013. On January 1, 2014, Medicare started new contracts with suppliers in these 9 areas for certain competitively bid product categories. It’s important to know if you’re affected by these changes to make sure Medicare will help pay for your equipment or supplies and to avoid any disruption of service.
What items are included in the Round 1 areas?
- Respiratory equipment and related supplies and accessories - includes oxygen, oxygen equipment, and supplies; Continuous Positive Airway Pressure (CPAP) devices and Respiratory Assist Devices (RADs) and related supplies and accessories; and standard nebulizers
- Standard mobility equipment and related accessories - includes walkers, standard power and manual wheelchairs, scooters, and related accessories
- General home equipment and related accessories - includes hospital beds and related accessories, group 1 and 2 support surfaces, transcutaneous electrical nerve stimulation (TENS) devices, commode chairs, patient lifts, and seat lifts
- Enteral nutrients, equipment and supplies
- Negative Pressure Wound Therapy pumps and related supplies and accessories
- External infusion pumps and supplies
I live in a Round 1 ZIP code where new contracts started on January 1, 2014. Do I have to change suppliers if I was renting equipment from a supplier that doesn’t have a new contract with Medicare?
Suppliers that don’t get Medicare contracts can decide to become "grandfathered" suppliers. This means a supplier may continue to rent equipment to you if you were renting the equipment as of January 1, 2014. This rule applies to oxygen, oxygen equipment, and certain rented equipment. You may continue using the “grandfathered” supplier until the rental period for your equipment ends.
If you start renting additional equipment from a “grandfathered” supplier after January 1, 2014, Medicare won’t pay for the new equipment.
If you’re renting equipment that’s eligible for grandfathering, your supplier will let you know in writing 30 business days before the program begins whether it will or won’t become a “grandfathered” supplier.
If your supplier doesn’t choose to grandfather, you’ll need to use a new contract supplier for Medicare to help pay for your equipment.