Changes Coming to Medicare Medical Equipment Program; What You Need to Know

Medicare patients who use durable medical equipment, prosthetics, orthotics or supplies (DMEPOS) items will soon see changes due to a new program that requires these items to be furnished by a Medicare contract supplier. Health care providers play a key role in helping their patients understand how they will be affected by this change and what they need to do in order to continue to receive the high-quality equipment and supplies they need. Starting Jan. 1, 2011, if your patients with Original Medicare live in Cleveland-Elyria or Mentor and they need to obtain any of the equipment or supplies included in the program (listed below), they will almost always have to use Medicare contract suppliers for Medicare to help pay for the item.

The products and equipment included in the program are:

• Oxygen, oxygen equipment, and supplies

• Standard power wheelchairs, scooters, and related accessories

• Complex rehabilitative power wheelchairs and related accessories (Group 2 only)

•  Mail-order diabetic supplies

• Enteral nutrients, equipment, and supplies

• Continuous positive airway pressure (CPAP) devices and respiratory assist devices (RADs) and related supplies and accessories

• Hospital beds and related accessories

• Walkers and related accessories

• Support surfaces (Group 2 mattresses and overlays in Miami-Fort Lauderdale-Pompano Beach only)

If your patients currently rent oxygen or certain other items such as Continuous Positive Airway Pressure (CPAP) machines, they may be able to continue renting these items from their current supplier when the program takes effect, if the supplier decides to participate in the program as a “grandfathered” supplier.

Medicare has resources to help your patients understand the new program, including 1-800-MEDICARE and www.medicare.gov . Consumers can also call their local State Health Insurance Assistance Program (SHIP) for free health insurance counseling and personalized help understanding the program. If your patient is in a Medicare Advantage Plan (like an HMO or PPO), their plan will notify them if their supplier is changing. They should contact their plan for more information.

Consult the list of contract suppliers on www.medicare.gov  (or request a list through 1-800-MEDICARE) to determine whether their current supplier has been approved as a Medicare contract supplier for their area and may continue to supply the equipment and services they need with Medicare coverage. If their current supplier is a contract supplier for their equipment, they don’t need to do anything.