Competitive Bidding:
Know Grandfathering Rules Before Taking The Plunge
Published on Tue May 27, 2008
Grandfathering period limited, CMS says.
Deciding to furnish oxygen as a non-contract supplier under competitive bidding may seem like less of a good idea when you learn the facts about grandfathering.
Durable medical equipment suppliers who didn't win bidding contracts need to make their decisions soon on whether they will furnish bid items to existing clients, noted the Centers for Medicare & Medicaid Services in its May 13 Open Door Forum for home care providers.
"Suppliers need to make these grandfathering decisions in the very near future and inform beneficiaries," CMS' Joel Kaiser stressed in the forum. CMS has issued specific requirements for the notification letters which all suppliers in bid areas must send to their patients (see Eli's HCW, Vol. XVII, No. 19).
But suppliers may not realize what grandfathering allows--and doesn't allow. Suppliers can furnish the bid item and any accessories and supplies necessary for the item, Kaiser said in response to a caller's question.
Limited time: But that lasts only through the end of the item's rental period if it's a capped rental item. So, if you furnish oxygen equipment, you'll only be able to furnish the oxygen contents while the beneficiary is renting the equipment.
Once the bene takes ownership of the item--the 37th month for oxygen patients--you no longer are allowed to furnish the oxygen itself under bidding. If the patient owns the equipment and just needs replacement contents, those aren't subject to grandfathering, Kaiser explained.
The same goes for items such as continuous positive airway pressure (CPAP) devices in the 13th month, CMS told the caller.
Not good enough: The notification letter examples CMS has given suppliers don't do a good job of explaining the limited time period for grandfathering, the caller protested.
Suppliers also should understand that they can't choose to grandfather some patients and not others for the same item. They can pick and choose which items to continue furnishing under grandfathering, but not which patients will receive those item(s), Kaiser instructed. Don't Pick Up Equipment Too Early If you decide not to grandfather equipment under bidding, there are stringent rules for when you may pick up your equipment from the beneficiary, Kaiser emphasized in the forum that drew more than 600 attendees.
You can't pick up your equipment before bidding starts on July 1, Kaiser instructed. And "you can't pick it up before the end of that last rental month," he added.
Example: If your patient's rental period starts June 30, you can't pick it up until the last week of the rental month--the last week of July--even though bidding starts July 1.
CMS has announced some exceptions in the bidding program. For example, even though oxygen is now a 36-month capped rental item, suppliers who take on new oxygen patients are eligible [...]
