Instructions for Submitting Letters on Competitive Bidding to CMS

1. Create a letter using the information in the Sample letter. (Don’t simply copy and use this. Each letter should be specific to the person writing it.)
2. Submit your comment by August 29, 2025 at:
   Federal Register :: Medicare and Medicaid Programs; Calendar Year 2026 Home Health Prospective Payment System (HH PPS) Rate Update; Requirements for the HH Quality Reporting Program and the HH Value-Based Purchasing Expanded Model; Durable Medical Equipment, Prosthetics, Orthotics, and Supplies (DMEPOS) Competitive Bidding Program Updates; DMEPOS Accreditation Requirements; Provider Enrollment; and Other Medicare and Medicaid Policies (This link should take you to the appropriate page on the Federal Register to submit your comments.)
3. Click on the green box – (Submit a Public Comment)
4. Follow the simple step-by-step process to submit your comments
   1. Enter your comments
   2. The next section is a drop-down menu asking what is your comment about? Choose the option that best fits your role (e.g. Clinicians should choose Healthcare Provider/Association. Consumers should choose “Individual”)
   3. Upload files (if applicable)
   4. Enter your email address (optional)
   5. The next section asks, tell us about yourself? Choose one of the three options (i.e., An Individual, An Organization, Anonymous). Complete the fields based on the option you chose.
   6. In the next section, read and then click on “I read and understand the statements above.”
5. Click on Submit Comment (to the right of this button you have the option to preview comment)

Sample Letter

Subject: Comment on CMS-1828-P – Opposing Inclusion of Urological Supplies in Competitive Bidding

Dear Centers for Medicare & Medicaid Services,

I am writing to express my strong concern about the proposed rule CMS-1828-P and the potential inclusion of urological supplies—such as intermittent catheters—in the Medicare Competitive Bidding Program (CBP).

My name is [Insert your name], and I am a [person living with Spina Bifida / parent of a child with Spina Bifida / healthcare provider / urology specialist]. I am deeply concerned that this rule will jeopardize access to the critical, individualized medical supplies that people with Spina Bifida need to safely manage neurogenic bladder and avoid life-threatening infections.

Individuals with Spina Bifida often require lifelong catheterization, and finding the right catheter can take years of trial and error. These supplies are not interchangeable, and changes in brand, size, lubrication, or material can cause pain, injury, or serious urinary tract and kidney infections. Once an effective product is found, continuity is essential to prevent emergency room visits, hospitalizations, and long-term health complications.

I am concerned that this rule will:

• Force people to switch to cheaper, lower-quality products that may not work for them
• Disrupt relationships with trusted suppliers who understand our unique needs
• Delay delivery or limit product availability—especially for those in rural or underserved communities
• Increase out-of-pocket costs and reduce autonomy in care decisions

As someone directly impacted by this issue, I ask that CMS:

1. Exclude urological supplies from the Competitive Bidding Program
2. If not excluded, provide an exemption pathway for individuals with complex neurological conditions such as Spina Bifida
3. Require a transition plan and patient protections to ensure access to the right products and timely delivery
4. Involve patients and clinicians in decisions about which products are appropriate for bidding

Access to the right urological supplies is not a convenience—it is a lifesaving medical necessity. I urge CMS to reconsider this proposal and protect the health and dignity of people living with complex medical needs.

Thank you for the opportunity to comment.

Sincerely,
[Your Full Name]
[Your City, State]
(Optional: [Credentials or Title if a Healthcare Provider])
(Optional: Email or contact info)

Talking Points on Impact of Competitive Bidding on Access to Care

• Competitive bidding treats catheters as interchangeable commodities. Catheters are not just any product. They require a prescription and are provided by clinicians based on each patient’s unique anatomy, mobility, and health history. Competitive bidding may lead to unsafe substitutions.
• Competitive bidding increases the risk of medical complications. Wrong or lower-quality products increase the risk of urinary tract infections, kidney damage, and hospitalizations — all of which are common, preventable complications in Spina Bifida.
• Competitive bidding disrupts established care. It may force patients to change suppliers or products abruptly. This breaks continuity of care and requiring time-consuming retraining.
• Competitive bidding creates a threat to independence and quality of life. Reliable access to the right supplies allows people with Spina Bifida to attend school, work, and live independently. Delays, denials, or substitutions directly impact health and daily functioning.
• Competitive bidding may not save money in the long run. It is intended to save costs, but it can drive up overall healthcare spending due to increased ER visits, hospital admissions, and long-term complications.
• Competitive bidding harms Medicare beneficiaries. Many adults with Spina Bifida rely on Medicare and already face coverage barriers. Competitive bidding adds another layer of restriction, making it harder to get essential supplies.

Additional Resources

Protect Access to Home Medical Equipment & Supplies
Understanding Competitive Bidding Impact on Home Medical Equipment & Supplies
Understanding Competitive Bidding Impact on Ostomy Supplies
Understanding Competitive Bidding Impact on Urological Supplies