Ombudsman Program The Ombudsmen for the DMEPOS Competitive Bidding Program are now available to assist providers, suppliers, and beneficiaries by providing information and education and by facilitating the resolution of complaints and concerns. The ombudsmen's role is to investigate and address complaints by providers, suppliers, and beneficiaries specifically related to the Competitive Bidding Program. There are eight ombudsmen who are located within the initial Competitive Bidding Areas (CBAs). You may contact an ombudsman: For general information about the DMEPOS Competitive Bidding Program; To obtain assistance in locating a contract supplier; For educational programs and activities; To report concerns about the program, a supplier, or a referral agent; The quality of services or items, and/or suspected fraud or abuse; and For assistance with questions, issues, and complaints specifically pertaining to the competitive bidding program and policies. You may find a list of the ombudsmen with contact information on the DMEPOS Competitive Bidding Implementation Contractor (CBIC) website at www.dmecompetitivebid.com. DMEPOS Competitive Bidding Program Competitive Bidding Areas (CBAs) Are Defined by Zip Codes Two CBA zip code files have been posted on the Competitive Bidding Implementation Contractor (CBIC) website: one file containing mail order zip codes per CBA and one file containing non-mail order zip codes per CBA. These files will be updated on a quarterly basis, as needed, to reflect changes in zip codes included in the various CBAs. Although the boundaries of a CBA will not change during a competitive bidding contract period, zip codes in general do change from time to time (e.g., when one zip code/area is subdivided into two or more new zip codes/areas, etc.). Zip codes contained in each CBA can be accessed through the CMS DMEPOS Competitive Bidding website at located at www.cms.hhs.gov/DMEPOSCompetitivebid/. Just click on the "Metropolitan Statistical Areas, Competitive Bidding Areas, and Zip Codes" tab and scroll down to "Related Links Outside CMS". Important Requirements of the "Grandfathered" Supplier Provision Non contract suppliers located in the 10 DMEPOS Competitive Bidding Areas (CBAs) should have taken the appropriate steps to notify beneficiaries whose permanent residence is in a CBA of their decision to become, or not to become grandfathered suppliers for each competitively bid item. These decisions should be conveyed through a written notification to the beneficiary before July 1, the start date of the new program. IMPORTANT NOTE: This notification should only be sent to beneficiaries who maintain a permanent residence in a CBA. Suppliers can determine if a beneficiary resides in a CBA by comparing the beneficiary's zip code to the zip code files on the Competitive Bidding Implementation Contractor's web site. Suppliers that choose to become "grandfathered" should maintain a record as to whether the beneficiary chose to continue to receive the item from the grandfathered supplier, chose to go to a contract supplier, or did not respond. For suppliers that choose not to become grandfathered, the beneficiary will have to switch to a contract supplier. CMS expects suppliers to work together to ensure there is no break in service or in the furnishing of medically necessary items (e.g. oxygen, enteral nutrition, CPAP). In order for this transition to occur, a coordinated effort including delivery and pick-up of supplies must take place. For more detailed information on this topic, please refer to the MLN Matters article MM5978 and the Medicare Learning Network's Tip Sheet for "Grandfathered" Suppliers on the CMS DMEPOS Competitive Bidding website located at www.cms.hhs.gov/DMEPOSCompetitivebid/. Go to the "Provider Educational Products and Resources" tab and scroll to the "Downloads" section. | | | Downloads |
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