What are the rules about kinds of supplies covered in the DME Competitive Bidding Program?

Starting July 2013, Medicare will implement a National Mail-Order Program for diabetic testing supplies. When it starts, you’ll need to use a Medicare national mail-order contract supplier for Medicare to pay for diabetic testing supplies that are delivered to your home. If you don’t want diabetic testing supplies delivered to your home, you can go to any local store (local pharmacies or storefront suppliers) that’s enrolled with Medicare and buy them there.

This new program doesn't require that you change your testing monitor. If you're happy with your current monitor, look for a mail-order contract supplier or local store that can provide the supplies you need.

If you switch suppliers, you might need to get a new prescription for testing supplies or arrange to have your current prescription transferred. Plan ahead before you run out of supplies.

Depending on how long you've been renting your enteral nutrition equipment (feeding pump), you might not need to get the equipment from a contract supplier.

• If you've been renting an enteral infusion pump on a continuous basis for more than 15 months, your supplier must continue to provide you with the pump as long as it's medically necessary even if the supplier isn't a contract supplier. If your current supplier isn't a contract supplier, it isn't allowed to pick up the pump from you because Medicare is still covering it.
• If you've been renting an enteral infusion pump for less than 15 months, and your current supplier isn't a Medicare contract supplier under the new program, then you'll have to change suppliers. However, your current supplier isn't allowed to pick up any equipment or supplies from you until the last day of the last rental month that began before January 1, 2011. Your current supplier and your Medicare contract supplier must work together and coordinate to make sure you have the equipment you need. For example, if you have paid for a rental pump with your current supplier through the end of December, they must continue to provide the equipment you need through December 31 and make sure they work with your new supplier so that you don't have any interruptions in service.

• Under current rules for oxygen, Medicare pays suppliers a monthly fee for providing all medically necessary oxygen and oxygen equipment, including accessories and supplies like tubing or a mouthpiece. After you've met your yearly Part B deductible, Medicare pays 80% of the allowed amount, and you pay 20%.
  • After 36 months of continuous use, Medicare stops making rental payments for the oxygen equipment, but you'll, in almost all circumstances, continue to get the oxygen equipment, accessories, and supplies from the same supplier with no rental charge until the end of the reasonable useful lifetime of the oxygen equipment (generally 5 years after the date that the equipment was delivered to you).
  • If you've been renting your equipment for 27 to 35 months and you switch to a Medicare contract supplier, you may have to pay for renting the equipment for a few months longer than expected (from one to nine months beyond the 36 month period) before your rental payments stop. This will result in additional months of coinsurance. However, the amount you pay will be lower than before because the amount you'll pay will be based on the new payment rates under the competitive bidding program. Talk with your new supplier about how this affects you.
• If you've been renting your equipment for 36 months, you don't need to do anything. Your current supplier must continue to provide your equipment at no additional rental charge until the equipment needs to be replaced because it has reached the end of its reasonable useful lifetime. When your old equipment needs to be replaced because it's too old, you must get replacement equipment from a contract supplier.

Under current Medicare rules, you own these types of equipment after renting for 13 months. When you switch to a Medicare contract supplier instead of using a "grandfathered" supplier or other non-contract supplier, your 13-month rental period will start over, so you won't own the equipment until after the new rental period ends. This will extend your rental period and result in additional months of coinsurance. However, the amount you pay will be lower because the amount you'll pay will be based on the new payment rates under the new program.

• Once you own the equipment, you must get replacement supplies and accessories for the equipment from a contract supplier in order for Medicare to help you pay for these items. You may obtain repairs for the equipment you own from any Medicare-approved supplier (even a non-contract supplier), including replacement parts needed for the repair.
• If you already own your equipment, you must use a Medicare contract supplier for your replacement supplies and accessories (like masks used with the CPAP device).