CMS Finalizes Rule Changing The Next Round Of The Competitive Bidding Program And Updating Other Provisions Related To Provider Enrollment And Prior Authorization

Published in Government Relations on December 01, 2025

Final Rule Analysis from the VGM Payer Relations and Reimbursement team

On Nov, 28, 2025, CMS finalized Final Rule CMS-1828-F that includes updates to the Competitive Bidding Program (CBP) and other provisions related to provider enrollment and prior authorization. Next round is expected to be implemented no later than Jan. 1, 2028.

CMS has also announced product categories for the new Remote Item Delivery (RID) CBP and an estimated timeline for the next round as whole in a fact sheet. The fact sheet lists the RID CBP product categories to be included in the next round and also indicates that in late spring/early summer 2026, DMEPOS CBP product categories will be announced along with the number of contracts to award for each product category for the program as a whole.

Final Rule highlights:

New CBP Product Categories

Ostomy, tracheostomy, and urological supplies
- Definitions were revised to categorize each as medical equipment and thus subject to CBP inclusion
Continuous glucose monitoring (CGM) and insulin pumps
- Class II reclassified under the Frequent and Substantial Servicing (FSS) payment category
- Payment on a bundled monthly rental basis for both CBP and non-CBP areas
Off-the-shelf upper extremity orthotics

Remote Item Delivery (RID) CBP

Creates a remote item competitive bid program for products that are frequently drop shipped, delivered, or picked up at a contracted supplier location
Products announced via the fact sheet for inclusion in the RID CBP are:
- Ostomy
- Urological
- Hydrophilic urinary catheters
- CGM
- Off-the-shelf upper extremity orthotic products
- Off-the-shelf back and knee orthotic products

DMEPOS CBP

Product categories not included in the RID program are to be announced early spring/late summer 2026 along with the lead item for each category and the number of contracts to be awarded

SPA Calculation

Revises SPA calculation to use the 75th percentile of winning bids for the lead item instead of the maximum winning bid
Revises the ratio for non-lead items in a product category to be based on the 2015 fee schedule rate for each specific CBA (rather than the national average that was used for Round 2021)

Contract Award Determinations

Limits the required number of contracts to less than ten (10) per each product category

Bid Limits and Conditions for Awarding Contracts if Savings are Not Expected

Items included for the first time: The bid limits would be the then current fee schedule
Previously included items: The bid limits would be the most recent SPA for the items plus 10 percent. If it has been more than a year since the SPA was last in effect, the inflation-adjusted SPA plus 10 percent.
In no event would the bid limit be allowed to exceed the unadjusted fee schedule amount

Financial Documentation Changes

Limited to:
- A credit report with a numerical credit score and/or rating from one of the four approved credit reporting agencies during the bid window; or if not available, a business credit report showing no data or insufficient information to generate a score or rating plus a personal credit report with a numerical credit score or rating from the bidding entity’s Authorized Official or Delegated Official in the Medicare Provider Enrollment, Chain, and Ownership System (PECOS)
Bid surety bond in the amount of $50,000 for each CBA for which submitting a bid. Bid surety bonds are specific to the CBP and are an additional bond to what is required to maintain billing privileges.

New Contract Clause

Addition of a new clause allowing CMS to unilaterally terminate or modify supplier contracts if certain conditions are met due to a PHE allowing CMS to revert to the general fee-for-service program requirements.

Other Provisions Outside of CBP

Accreditation

Requires DME suppliers to get reaccredited annually instead of every three (3) years

Provider Enrollment

Provides several instances in which PTANs may be revoked retroactively
Requires Authorized Official signature for liability insurance

Prior Authorization

Creates a prior authorization exemption program of certain DMEPOS products for suppliers that reach an affirmation threshold of 90%

Education and Resources:

Webinar this Wednesday, Dec. 3, 11 a.m. CST: Understanding the Final Rule on the DMEPOS Competitive Bidding Program

Join VGM for a live webinar on Wednesday, Dec. 3 at 11 a.m. CST as we break down the latest updates to the Competitive Bidding Program and what they mean for your business.

Featured Experts:

Melanie Ewald – VP of Payer Relations & Reimbursement
Ronda Buhrmester – Sr. Director of Payer Relations & Reimbursement
Kelly Grahovac – General Manager, The van Halem Group

This team has spent countless hours analyzing the Final Rule to provide you with the most accurate and actionable insights. They’ll walk you through the bidding program process and answer your questions live.

Don’t miss this opportunity to stay informed and prepared!

Sign up for the webinar here.

The van Halem Group

If you are interested in the program and want to determine if a bid submission is right for your organization, we can help! The van Halem Group offers consultation services related to Competitive Bid

Click here.