House-approved bill HR 6331, which would include a measure to delay implementation of the highly controversial DMEPOS bidding program for 18 months, has hit challenges in both the first Senate vote on the bill, and from a bipartisan group of senators who are advocating that the bill be opposed.

On June 24, the House of Representatives voted to pass HR 6331. However, just two days later, the Senate failed to pass a cloture motion on the bill (for accelerated voting without filibuster--at this point in the legislation, a cloture vote tests whether Congress is ready to end debate and proceed to a vote) which indicates the bill itself will be delayed and its prospects of passing are significantly impacted. (See DOTmed story at DM 6348, and further DMEPOS news at DM 6417). Groups such as the American Association for Homecare had strongly urged the Senate to pass the bill, in hopes that the delay in implementation would allow purported flaws in the program to be addressed. (The bill also averts a severe reduction to Medicare physician pay rates. The bill may be reintroduced after the July 4 recess.)

Shortly after the Senate vote, a bipartisan group of five senators submitted a letter to Senate leaders urging opposition to 6331, according to a report from CQ Healthbeat. The letter was addressed to Senate Majority Leader Harry Reid (D-Nev.) and Minority Leader Mitch McConnell (R-Ky.) and signed by Sens. John Rockefeller (D-W.Va.), Tom Coburn (R-Okla.), John Kerry (D-Mass.), Dianne Feinstein (D-Calif.) and Larry Craig (R-Idaho). The letter stated that concerns about the DMEPOS bidding program "can be addressed without legislatively delaying" the implementation, which was scheduled to take effect Tuesday.

Under the program, CMS will select DME suppliers to participate in Medicare based on winning bids they submit. The 2003 Medicare law mandated the program as part of a larger effort to implement competitive bidding. In 2008, the program will operate in 10 of the largest Metropolitan Statistical Areas and will apply to 10 of the top DME, prosthetics, orthotics and supplies product categories. In 2009, the program will expand to an additional 70 MSAs and expand further in following years. CMS says that the program likely will result in an average 26% decrease in the prices of medical equipment in the 10 MSAs. (Kaiser Daily Health Policy Report, 6/26)

The letter also stated that full implementation of the program would save $1 billion annually, resulting in lower coinsurance for Medicare beneficiaries. The letter says competitive bidding "ensures that beneficiaries receive their (durable medical equipment) from accredited and financially viable suppliers, two important safeguards that beneficiaries did not have prior to competitive bidding." (CQ Healthbeat 6/26)