September 19, 2008
Medicare Part B drug competitive acquisition program postponed for 2009
Effective Date: N/A
Implementation Date: N/A
Summary
The contract with the current approved competitive acquisition program (CAP) vendor, BioScrip Inc., will remain in effect through December 31, 2008. Physicians who are currently participating in the CAP must transition back into the average sales price (ASP) method of acquiring part B drugs for services provided on or after January 1, 2009.
Claims processing for the CAP will continue past January 1, 2009, for claims with dates of service through December 31, 2008. The physician election period for 2009 that was scheduled for October 1 to November 15, 2008 will not be held.
Key points
CAP is postponed for 2009
Earlier this year, CMS accepted bids for vendor contracts for the 2009-2011 CAP. While CMS received several qualified bids, contractual issues with the successful bidders resulted in CMS postponing the 2009 program.
Earlier this year, CMS accepted bids for vendor contracts for the 2009-2011 CAP. While CMS received several qualified bids, contractual issues with the successful bidders resulted in CMS postponing the 2009 program.
Drug ordering
The contract with the current approved CAP vendor, BioScrip Inc., will remain in effect through December 31, 2008. After January 1, 2009, physicians must obtain and bill for drugs through the ASP process, and physicians will also be responsible for collecting applicable deductible and co-insurance from Medicare beneficiaries.
The contract with the current approved CAP vendor, BioScrip Inc., will remain in effect through December 31, 2008. After January 1, 2009, physicians must obtain and bill for drugs through the ASP process, and physicians will also be responsible for collecting applicable deductible and co-insurance from Medicare beneficiaries.
Claims processing and billing
Participating CAP physicians must submit CAP claims to their local carrier or Medicare administrative contractor (MAC) within 30 days of CAP drug administration.
Participating CAP physicians must submit CAP claims to their local carrier or Medicare administrative contractor (MAC) within 30 days of CAP drug administration.
CAP training during the transition
This fall, CMS will provide guidance and training for participating CAP physicians on how to transition out of the program at the end of the year.
This fall, CMS will provide guidance and training for participating CAP physicians on how to transition out of the program at the end of the year.
Additional information is available on the CMS Web site. Here is the link to the MLN Matters article SE0833 
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.Source: CMS MLN Matters Special Edition Article SE0833
