1. Short title
This Act may be cited as the “Transparency and Accountability in Medicare Bidding Act of 2013”.
Transparency and Accountability in Medicare Bidding Act of 2013
A BILL
To delay for at least 6 months the implementation of round 1 recompete and round 2 of the Medicare durable medical equipment (DME) competitive bidding program and of the national mail order program for diabetic testing supplies to permit Congress an opportunity to reform the competitive bidding program, to provide for an evaluation of that program by an auction expert team, and for other purposes.
2. Delay in implementing the Medicare DME competitive bidding program and the national mail order program for diabetic testing supplies
In general— Notwithstanding any other provision of law, the Secretary of Health and Human Services shall delay from July 1, 2013, to a date that is no earlier than December 31, 2013, the dates of implementation of—
round 2 of the DMEPOS competitive bidding program under section 1847 of the Social Security Act (42 U.S.C. 1395w–3); and
the single payment amounts under the national mail order competition for diabetic supplies under such section.
Round 1 recompete delay— Notwithstanding any other provision of law, the Secretary of Health and Human Services shall delay the start of round 1 recompete of such DMEPOS competitive bidding program from January 1, 2014, to a date that is no earlier than 6 months after the date of initial implementation of round 2 of such program.
3. Evaluation of DMEPOS competitive bidding program by auction expert team
In general— The Secretary of Health and Human Services (in this section referred to as the “Secretary”), not later than 3 months after the date of the enactment of this Act and acting through the Office of the Assistant Secretary for Planning and Evaluation, shall contract 3 auction experts, a health economist, and an econometrician to work as a team (in this section collectively referred to as the “auction expert team”), led by the auction experts, to independently review and assess all aspects of round 1 re-bid and round 2 of the DMEPOS competitive bidding program under section 1847 of the Social Security Act (42 U.S.C. 1395w–3), including the design, development, implementation, adequacy of support for Medicare beneficiaries with chronic illness or disabilities, market fairness, sustainability, and functioning of such program.
Selection of auction expert team—
In general— The selection of the experts on the auction expert team under subsection (a) shall be undertaken through a competitive process.
Disqualifications— An individual shall not be selected for the auction expert team if such individual—
is a current or former employee of the Centers for Medicare & Medicaid Services;
is a current or former contractor for the Centers for Medicare & Medicaid Services that participated in the design or implementation of the DMEPOS competitive bidding program;
does not have significant experience in implementing auctions of similar complexity in government programs; and
does not have appropriate educational credentials.
Access to information— The Secretary shall make available to the auction expert team all applicable information (including confidential information) on the DMEPOS competitive bidding program in its entirety (including information on its design and the bidding under round 1, round 1 re-bid, and round 2).
Report to Secretary and Congress—
In general— Not later than 4 months after the date the Secretary enters into the contract with the experts under subsection (a), the auction expert team shall submit a report to the Secretary and to the Congress on its assessment and review under subsection (a).
Items to be included in report— Such report shall include the following and shall identify all potential problems with the DMEPOS competitive bidding program:
A review and assessment of the appropriateness of HCPCS codes selected for auctions.
An evaluation and assessment of the ability of individuals eligible for the DMEPOS items subject to the program to obtain these items and services, including an assessment of utilization patterns.
An analysis of any current or future adverse effects on beneficiaries’ health outcomes related to the program and related costs to the Medicare trust fund, including an analysis of those beneficiaries in each competitively bid area who did not continue to receive such items and the effect on their Medicare claims under parts A, B, and D.
An identification and report on the cause of any material deterioration in the quality of items and services provided to an individual eligible for DMEPOS benefits under the program.
An evaluation of the costs of any preventable or prolonged hospitalizations due to lack of timely access to items and related services subject to the program.
An identification, for each product category and competitive bid area in the round 1 re-bid, of the following:
The original winning bidders which signed contracts and the number of allowed unique Medicare beneficiaries each contracting supplier fulfilled annually for the calendar years 2010, 2011 and 2012 in the competitive bidding areas.
How many contracting suppliers failed to submit beneficiary product claims for more than 60 consecutive days.
An identification of DMEPOS suppliers added after January 1, 2011, and the number of allowed unique Medicare beneficiaries each such added supplier served annually for the calendar years 2010, 2011 and 2012 in the competitive bidding areas.
An identification, for each product category and each competitive bidding area in the round 1 re-bid and in round 2, of the following:
The number of winning suppliers.
The number of such winning suppliers which have not previously supplied the DMEPOS products bid for in the competitive bidding area.
The total actual unique Medicare beneficiaries served by such winning suppliers, for 2010 with the round 1 re-bid and 2012 for round 2.
The total capacity, measured by unique Medicare beneficiaries to be served by such winning suppliers, as estimated by Secretary to meet the needs of seniors during the contracting period.
Such total capacity as bid by the winning bidders.
The total capacity attributed by the Secretary to the winning bidders.
Recommendations— Such report shall also include such recommendations for changes in such program as the auction expert team determines appropriate, including recommendations that respond to all the potential problems identified under paragraph (2).