Bill Overview
Title: DRA of 2022
Description: This bill increases payment adjustments for certain items that were included in Round 2021 of the Medicare Durable Medical Equipment, Prosthetics, Orthotics, and Supplies (DMEPOS) Competitive Bidding Program but for which contracts were not executed. The bill applies to items that are furnished between January 1, 2022, and December 31, 2023, and that were not subject to the unadjusted fee schedule amount as of January 1, 2021. Under the DMEPOS Competitive Bidding Program, the Centers for Medicare & Medicaid Services (CMS) sets payment for certain durable medical equipment under Medicare based on a competitive bidding process with suppliers, rather than the fee schedule amount. The CMS included 16 product categories in Round 2021 of the program but ultimately did not award contracts for 13 of these categories (that were also in previous rounds) as the resulting payment amounts did not achieve expected savings.
Sponsors: Rep. Mullin, Markwayne [R-OK-2]
Target Audience
Population: People using durable medical equipment, prosthetics, orthotics, and supplies under Medicare
Estimated Size: 50000000
- The bill affects Medicare payments for durable medical equipment, prosthetics, orthotics, and supplies.
- The DMEPOS Competitive Bidding Program impacts suppliers of medical equipment and Medicare beneficiaries relying on such equipment.
- The bill only applies to items that were furnished between January 1, 2022, and December 31, 2023, not subjected to the unadjusted fee schedule amount initially.
- The bill specifically targets payment adjustments for 13 product categories where contracts were not executed in Round 2021.
Reasoning
- The DRA of 2022 specifically targets Medicare beneficiaries who rely on durable medical equipment but were left without contracts due to failed bids in Round 2021.
- The budget constraint limits how much the policy can improve wellbeing, requiring careful distribution especially to those most in need.
- Impacted individuals are those dependent on specific categories of equipment, so the policy may result in significant wellbeing changes for a subset of Medicare users.
- Not everyone on Medicare uses such equipment, so many individuals will see no change under this policy.
Simulated Interviews
Retired nurse (Fort Worth, Texas)
Age: 72 | Gender: female
Wellbeing Before Policy: 6
Duration of Impact: 2.0 years
Commonness: 15/20
Statement of Opinion:
- The DRA of 2022 is necessary because I've heard many older adults say they can't afford the equipment they need.
- Access to equipment such as CPAPs at a lower cost would greatly improve my quality of life.
Wellbeing Over Time (With vs Without Policy)
| Year | With Policy | Without Policy |
|---|---|---|
| Year 1 | 7 | 6 |
| Year 2 | 8 | 6 |
| Year 3 | 8 | 6 |
| Year 5 | 8 | 5 |
| Year 10 | 8 | 5 |
| Year 20 | 8 | 4 |
Retired engineer (Miami, Florida)
Age: 80 | Gender: male
Wellbeing Before Policy: 7
Duration of Impact: 2.0 years
Commonness: 10/20
Statement of Opinion:
- I am glad they're adjusting these payments, but I haven't faced too many issues with my equipment.
- It seems like a fair change, but it should have happened sooner.
Wellbeing Over Time (With vs Without Policy)
| Year | With Policy | Without Policy |
|---|---|---|
| Year 1 | 8 | 7 |
| Year 2 | 8 | 7 |
| Year 3 | 8 | 7 |
| Year 5 | 8 | 7 |
| Year 10 | 7 | 6 |
| Year 20 | 7 | 6 |
Retired teacher (Buffalo, New York)
Age: 65 | Gender: female
Wellbeing Before Policy: 5
Duration of Impact: 5.0 years
Commonness: 12/20
Statement of Opinion:
- If payment adjustments allow me to afford better braces or a new wheelchair, that would be a relief.
- The equipment isn't always affordable, so I hope this policy helps those struggling with costs.
Wellbeing Over Time (With vs Without Policy)
| Year | With Policy | Without Policy |
|---|---|---|
| Year 1 | 6 | 5 |
| Year 2 | 7 | 5 |
| Year 3 | 7 | 5 |
| Year 5 | 7 | 5 |
| Year 10 | 6 | 4 |
| Year 20 | 6 | 4 |
Disabled veteran (Chicago, Illinois)
Age: 50 | Gender: male
Wellbeing Before Policy: 6
Duration of Impact: 5.0 years
Commonness: 5/20
Statement of Opinion:
- These changes could help with the high costs of updating or repairing my prosthetics.
- If this policy can reduce my out-of-pocket expenses, I'm all for it.
Wellbeing Over Time (With vs Without Policy)
| Year | With Policy | Without Policy |
|---|---|---|
| Year 1 | 7 | 6 |
| Year 2 | 7 | 6 |
| Year 3 | 7 | 6 |
| Year 5 | 7 | 5 |
| Year 10 | 6 | 5 |
| Year 20 | 6 | 4 |
Retired librarian (Portland, Oregon)
Age: 88 | Gender: female
Wellbeing Before Policy: 5
Duration of Impact: 3.0 years
Commonness: 8/20
Statement of Opinion:
- The policy might help me afford the oxygen equipment I need.
- Being on a fixed income, any reduction in these costs would help.
Wellbeing Over Time (With vs Without Policy)
| Year | With Policy | Without Policy |
|---|---|---|
| Year 1 | 6 | 5 |
| Year 2 | 7 | 5 |
| Year 3 | 7 | 5 |
| Year 5 | 6 | 4 |
| Year 10 | 6 | 4 |
| Year 20 | 5 | 3 |
Retired firefighter (Los Angeles, California)
Age: 67 | Gender: male
Wellbeing Before Policy: 6
Duration of Impact: 1.0 years
Commonness: 10/20
Statement of Opinion:
- Hearing aids are pricey, and I appreciate any policy that makes them more affordable.
- I'm not sure how much this will help, but every little bit counts.
Wellbeing Over Time (With vs Without Policy)
| Year | With Policy | Without Policy |
|---|---|---|
| Year 1 | 6 | 6 |
| Year 2 | 6 | 6 |
| Year 3 | 6 | 6 |
| Year 5 | 6 | 5 |
| Year 10 | 5 | 5 |
| Year 20 | 5 | 4 |
Retired administrative assistant (Phoenix, Arizona)
Age: 76 | Gender: female
Wellbeing Before Policy: 4
Duration of Impact: 3.0 years
Commonness: 7/20
Statement of Opinion:
- I often have to choose between medical supplies and other essentials.
- This bill could mean one less thing to worry about.
Wellbeing Over Time (With vs Without Policy)
| Year | With Policy | Without Policy |
|---|---|---|
| Year 1 | 6 | 4 |
| Year 2 | 6 | 4 |
| Year 3 | 6 | 4 |
| Year 5 | 5 | 3 |
| Year 10 | 5 | 3 |
| Year 20 | 5 | 3 |
Retired butcher (Cincinnati, Ohio)
Age: 74 | Gender: male
Wellbeing Before Policy: 7
Duration of Impact: 4.0 years
Commonness: 10/20
Statement of Opinion:
- If this helps with dialysis costs, it should have come sooner.
- Many depend heavily on such equipment to maintain their health.
Wellbeing Over Time (With vs Without Policy)
| Year | With Policy | Without Policy |
|---|---|---|
| Year 1 | 7 | 7 |
| Year 2 | 8 | 7 |
| Year 3 | 8 | 7 |
| Year 5 | 8 | 7 |
| Year 10 | 7 | 6 |
| Year 20 | 7 | 6 |
Program manager in tech (Denver, Colorado)
Age: 55 | Gender: female
Wellbeing Before Policy: 8
Duration of Impact: 2.0 years
Commonness: 2/20
Statement of Opinion:
- While mostly geared for older adults, components of this policy could help my child.
- Any improvement in cost structures is beneficial.
Wellbeing Over Time (With vs Without Policy)
| Year | With Policy | Without Policy |
|---|---|---|
| Year 1 | 8 | 8 |
| Year 2 | 8 | 8 |
| Year 3 | 8 | 8 |
| Year 5 | 8 | 7 |
| Year 10 | 7 | 6 |
| Year 20 | 7 | 6 |
Retired contractor (Atlanta, Georgia)
Age: 69 | Gender: male
Wellbeing Before Policy: 6
Duration of Impact: 1.0 years
Commonness: 8/20
Statement of Opinion:
- I appreciate any help that can make my diabetic supplies cheaper.
- It's a good step, but I hope it expands to cover more products in the future.
Wellbeing Over Time (With vs Without Policy)
| Year | With Policy | Without Policy |
|---|---|---|
| Year 1 | 6 | 6 |
| Year 2 | 6 | 6 |
| Year 3 | 6 | 5 |
| Year 5 | 5 | 5 |
| Year 10 | 5 | 4 |
| Year 20 | 5 | 4 |
Cost Estimates
Year 1: $333000000 (Low: $250000000, High: $400000000)
Year 2: $300000000 (Low: $200000000, High: $350000000)
Year 3: $0 (Low: $0, High: $0)
Year 5: $0 (Low: $0, High: $0)
Year 10: $0 (Low: $0, High: $0)
Year 100: $0 (Low: $0, High: $0)
Key Considerations
- Limited duration from January 1, 2022, to December 31, 2023, dictates budgetary year estimates.
- Medicare beneficiaries accessing impacted DMEPOS items will directly or indirectly be affected by the reimbursement changes.
- Reliefs proposed within the act address long-standing issues with contract execution within the CMS program.