Disability organizations and advocates are rallying to urge community members to submit comments against a new rule proposed by the Centers for Medicare & Medicaid Services that could have far-reaching impacts on access to urological, ostomy and tracheostomy supplies. 

The proposed rule, issued June 30, would make products in these three areas — including intermittent catheters and daily colostomy supplies — subject to CMS’ competitive bidding program.  

Advocates and industry leaders believe this is a clear overreach of CMS’ legal authority and worry that exposing these products to competitive bidding will cut out many smaller, local DME providers and could curtail consumers’ access to the products they need. 

“Smaller, specialized suppliers for items like catheters or ostomy products likely won’t be able to compete on price alone,” says Jacqueline Smith, Coloplast’s senior manager, public affairs for North America. “Programs like this create a ‘race to the bottom’ where the focus could shift from quality and patient needs to the lowest possible cost.” 

Congress created the CBP in 2003 to lower Medicare spending on selected medical equipment and supplies. It limited the program to durable medical equipment, nutrients and off-the-shelf orthotics. These categories are very different than urological and ostomy supplies, which come in hundreds of customized styles that are essential for maintaining users’ quality of life. 

Steve Lieberman, United Spinal Association’s senior director of advocacy and policy, fears that in addition to driving some suppliers out of business, cutting their already thin margins will lead to a reduction in service, quality and product availability.  

“The real danger is in this space, where there are so many different kinds of products for so many different needs, that suppliers will close,” Lieberman says, “and then people who rely on a very particular kind of product will lose access to that product, and that there won’t be enough of that product to go around.” 

These same fears have played a role in halting previous attempts to consider urological and ostomy supplies for competitive bidding. In 2004, the Department of Health and Human Services drafted a report on competitive bidding and found that urological supplies were “not as well suited” for competitive bidding. The president’s 2017 budget proposal also requested the expansion of CBP to urological and ostomy supplies, though it did not end up included in Congress’ final budget. 

“I think the law is very clear in terms of, you’re not supposed to expand competitive bidding into this space,” says Lieberman. “What they are proposing runs counter to what has been established over the last two decades, and their own research has shown that what they are proposing doesn’t really achieve sufficient savings.” 

“We’re not going to take this without a fight,” says Lieberman. “Access to these supplies is really critical. It’s life or death for many people.” 

To help fight for disability rights, visit United Spinal’s action hub. You can sign up for the Grassroots Advocacy Network, contact your members of Congress and connect with other advocates from around the country.