A nova lei de licitações como promotora da maldição do vencedor / La nueva ley de licitaciones como promotora de la maldición del ganador / The new Brazilian public procurement law as promoter of the winner's curse

Resumo Evitar sobrepreços e preços manifestamente inexequíveis são dois objetivos principais da recém-promulgada Lei nº 14.133, de 1º de abril de 2021. O presente artigo demonstra que, ao tentar alcançar o primeiro objetivo, a nova lei de licitações promove o segundo, pois um comando específico tende a reduzir os preços até congelá-los nos menores valores possíveis, conduzindo os contratados à maldição do vencedor. Alerta-se os agentes públicos sobre o fato de que a manutenção desse comando levará a descumprimentos generalizados de contratos e a uma eventual falência de competidores. O método Monte Carlo é utilizado para demonstrar que um mecanismo abrangente de pesquisa de preços evitará o problema e garantirá o efeito pretendido pela lei.

Resumen Evitar los sobreprecios y los precios manifiestamente inviables son dos de los principales objetivos de la recién promulgada Ley 14.133/2021 de Brasil. Este artículo demuestra que, al intentar lograr el primer objetivo, la nueva ley de licitaciones promueve el segundo, ya que un comando específico tiende a reducir los precios hasta congelarlos a los valores más bajos practicables, llevando a los contratados a la maldición del ganador. Se advierte a los funcionarios públicos que mantener este comando conducirá a incumplimientos generalizados de contratos y eventual quiebra de los competidores. Se utiliza el método Monte Carlo para demostrar que un mecanismo integral de investigación de precios evitará el problema y garantizará el efecto buscado por la ley.

Abstract Avoiding overpricing and irresponsible pricing are two central objectives of the recently enacted Law 14133/2021. This article shows that when trying to achieve the first objective, the new Brazilian public procurement law promotes the second, since a specific command reduces maximum prices until they freeze to the lowest possible values, leading the contractors to the winner's curse. Public officials are warned that maintaining this command will lead to widespread breaches of contracts and eventual bankruptcy of contractors. The Monte Carlo method is adopted to show that a comprehensive price database will avoid the problem and guarantee the effect intended by the law.

Medicare Program; End-Stage Renal Disease Prospective Payment System, Payment for Renal Dialysis Services Furnished to Individuals With Acute Kidney Injury, End-Stage Renal Disease Quality Incentive Program, Durable Medical Equipment, Prosthetics, Orthotics and Supplies (DMEPOS) Competitive Bidding Program (CBP) and Fee Schedule Amounts, and Technical Amendments To Correct Existing Regulations Related to the CBP for Certain DMEPOS. Final rule.

This final rule updates and makes revisions to the End-Stage Renal Disease (ESRD) Prospective Payment System (PPS) for calendar year (CY) 2019. This rule also updates the payment rate for renal dialysis services furnished by an ESRD facility to individuals with acute kidney injury (AKI). In addition, it updates and rebases the ESRD market basket for CY 2019. This rule also updates requirements for the ESRD Quality Incentive Program (QIP), and makes technical amendments to correct existing regulations related to the Competitive Bidding Program (CBP) for certain Durable Medical Equipment, Prosthetics, Orthotics and Supplies (DMEPOS). Finally, this rule finalizes changes to bidding and pricing methodologies under the DMEPOS competitive bidding program; adjustments to DMEPOS fee schedule amounts using information from competitive bidding for items furnished from January 1, 2019 through December 31, 2020; new payment classes for oxygen and oxygen equipment and a new methodology for ensuring that new payment classes for oxygen and oxygen equipment are budget neutral; payment rules for multi- function ventilators or ventilators that perform functions of other durable medical equipment (DME); and revises the payment methodology for mail order items furnished in the Northern Mariana Islands. This rule also includes a summary of the feedback received for the request for information related to establishing fee schedule amounts for new DMEPOS items and services.

Medicare Program; End-Stage Renal Disease Prospective Payment System, Coverage and Payment for Renal Dialysis Services Furnished to Individuals With Acute Kidney Injury, End-Stage Renal Disease Quality Incentive Program, Durable Medical Equipment, Prosthetics, Orthotics and Supplies Competitive Bidding Program Bid Surety Bonds, State Licensure and Appeals Process for Breach of Contract Actions, Durable Medical Equipment, Prosthetics, Orthotics and Supplies Competitive Bidding Program and Fee Schedule Adjustments, Access to Care Issues for Durable Medical Equipment; and the Comprehensive End-Stage Renal Disease Care Model. Final rule.

This rule updates and makes revisions to the End-Stage Renal Disease (ESRD) Prospective Payment System (PPS) for calendar year 2017. It also finalizes policies for coverage and payment for renal dialysis services furnished by an ESRD facility to individuals with acute kidney injury. This rule also sets forth requirements for the ESRD Quality Incentive Program, including the inclusion of new quality measures beginning with payment year (PY) 2020 and provides updates to programmatic policies for the PY 2018 and PY 2019 ESRD QIP. This rule also implements statutory requirements for bid surety bonds and state licensure for the Durable Medical Equipment, Prosthetics, Orthotics, and Supplies (DMEPOS) Competitive Bidding Program (CBP). This rule also expands suppliers' appeal rights in the event of a breach of contract action taken by CMS, by revising the appeals regulation to extend the appeals process to all types of actions taken by CMS for a supplier's breach of contract, rather than limit an appeal for the termination of a competitive bidding contract. The rule also finalizes changes to the methodologies for adjusting fee schedule amounts for DMEPOS using information from CBPs and for submitting bids and establishing single payment amounts under the CBPs for certain groupings of similar items with different features to address price inversions. Final changes also are made to the method for establishing bid limits for items under the DMEPOS CBPs. In addition, this rule summarizes comments on the impacts of coordinating Medicare and Medicaid Durable Medical Equipment for dually eligible beneficiaries. Finally, this rule also summarizes comments received in response to a request for information related to the Comprehensive ESRD Care Model and future payment models affecting renal care.

Análise comparativa entre o RDC e a Lei 8.666 em obras e serviços de engenharia: uma perspectiva para a FIOCRUZ / Comparative analysis between the DRC and the Law 8666 in engineering works and services: a perspective for the FIOCRUZ

Este trabalho teve como objetivo fazer uma análise comparativa entre a Lei nº 8.666, de 21 de junho de 1993, considerada a Lei Geral de Licitações (LGL) e o Regime Diferenciado de Contratações Públicas (RDC), nova modalidade de licitação criada para atender às demandas dos grandes eventos esportivos mundiais sediados no Brasil, porém foi expandido para obras e serviços de engenharia para o Sistema Único de Saúde (SUS). O estudo identificou as vantagens e desvantagens dos modelos, os limites e avanços, bem como os recursos operacionais de cada um a fim de eleger o regime que apresente a forma mais adequada, com a otimização dos recursos, bem como garantias de prazos e qualidade necessários à efetiva realização das obras e serviços de engenharia, numa perspectiva para a FIOCRUZ. A metodologia adotada foi a pesquisa documental e bibliográfica, incluindo o espectro normativo vigente sobre o tema compras públicas. Da análise dos dados obtidos, evidenciou-se que a LGL é dotada de princípios eficazes e de determinantes essenciais ao bom agir da Administração Pública. Contudo, encontra-se obsoletada do ponto de vista operacional, com procedimentos inadequados às tecnologias da informação e aos recursos de eficiência que surgiram após a sua edição. Paralelamente, constatou-se que o RDC intensifica os princípios da LGL, além de se valer de muitos de seus ditames trazendo, ainda, a incorporação de todas as inovações positivas introduzidas no ordenamento jurídico das licitações nacionais e internacionais, promovendo agilidade e eficiência ao processo. Por fim, a conclusão que se apresenta, após considerar o referencial teórico e os dados obtidos na pesquisa, é a superioridade do RDC em relação à LGL. As recomendações finais se consubstanciam na proposição de melhorias nos processos de contratação da FIOCRUZ, com a adoção do RDC, a capacitação dos atores envolvidos no processo, bem como a elaboração de um manual de operação do RDC e a padronização dos editais de licitação, ações que servirão de auxílio à Instituição para que as previsões de manutenção de suas Unidades e de sua expansão em território nacional possam ser cumpridas, atendendo de forma eficiente ao interesse público.

This work aims the comparative analysis of law No. 8,666, June 21, 1993, considered the general law of Bids (LGL) and the Differential Regime of Public Contracts (RDC), new bidding mode created to meet the demands of major world sporting events hosted in Brazil, expanded to works and engineering services for the unified health system (SUS).The study identified the advantages and disadvantages of the models, the limits and advances, as well as the operational capabilities of each, in order to elect the regime to provide the most appropriate way, with resource optimization, deadlines and quality assurances, required the effective realization of works and engineering services, with a view to the FIOCRUZ. The methodology adopted was the documentary and bibliographical research, including prevailing regulatory and spectrum on the theme public purchases. The analysis of the data obtained, left evidenced that the LGL is equipped with effective principles and key determinants in the proper act of the public administration. However, if you find obsolete operational point of view, with inadequate procedures to information technologies that emerged after their issue. In addition, it was noted that the RDC intensifies the principles of LGL, as well as for many of his leadings, bringing the incorporation of all the positive innovations introduced in the legal framework of national and international bids, by promoting speed and efficiency to the process. Finally, the conclusion that, after considering the theoretical framework and the data obtained in the survey is the superiority of the RDC in relation to LGL. The final recommendations are on the proposition of improvements in hiring processes of FIOCRUZ, with the adoption of the RDC, training of the actors involved in the process, as well as the preparation of a manual of operation of the RDC and the standardization of bidding notices, actions that serve to aid the institution para forecasts of maintenance of their units and of its expansion in the national territory may be fulfilled in view of the public interest efficiently.

Medicare program; End-Stage Renal Disease prospective payment system, quality incentive program, and Durable Medical Equipment, Prosthetics, Orthotics, and Supplies. Final rule.

This final rule will update and make revisions to the End-Stage Renal Disease (ESRD) prospective payment system (PPS) for calendar year (CY) 2015. This rule also finalizes requirements for the ESRD quality incentive program (QIP), including for payment years (PYs) 2017 and 2018. This rule will also make a technical correction to remove outdated terms and definitions. In addition, this final rule sets forth the methodology for adjusting Durable Medical Equipment, Prosthetics, Orthotics, and Supplies (DMEPOS) fee schedule payment amounts using information from the Medicare DMEPOS Competitive Bidding Program (CBP); makes alternative payment rules for certain DME under the Medicare DMEPOS CBP; clarifies the statutory Medicare hearing aid coverage exclusion and specifies devices not subject to the hearing aid exclusion; will not update the definition of minimal self-adjustment; clarifies the Change of Ownership (CHOW) and provides for an exception to the current requirements; revises the appeal provisions for termination of a CBP contract, including the beneficiary notification requirement under the Medicare DMEPOS CBP, and makes a technical change to the regulation related to the conditions for awarding contracts for furnishing infusion drugs under the Medicare DMEPOS CBP.

Competitive bidding for Medicare Part B clinical laboratory services.

The traditional Medicare fee-for-service program may be able to purchase clinical laboratory test services at a lower cost through competitive bidding. Demonstrations of competitive bidding for clinical laboratory tests have been twice mandated or authorized by Congress but never implemented. This article provides a summary and review of the final design of the laboratory competitive bidding demonstration mandated by the Medicare Modernization Act of 2003. The design was analogous to a sealed bid (first price), clearing price auction. Design elements presented include covered laboratory tests and beneficiaries, laboratory bidding and payment status under the demonstration, composite bids, determining bidding winners and the demonstration fee schedule, and quality under the demonstration. Expanded use of competitive bidding in Medicare, including specifically for clinical laboratory tests, has been recommended in some proposals for Medicare reform. The presented design may be a useful point of departure if Medicare clinical laboratory competitive bidding is revived in the future.

Medicare program; revisions to the durable medical equipment, prosthetics, orthotics, and supplies (DMEPOS) supplier safeguards. Final rule.

This final rule removes the definition of "direct solicitation'' and allows DMEPOS suppliers, including DMEPOS competitive bidding program contract suppliers, to contract with licensed agents to provide DMEPOS supplies, unless prohibited by State law. It also removes the requirement for compliance with local zoning laws and modifies certain State licensure requirement exceptions.

Medicare program; payment policies under the physician fee schedule and other revisions to Part B for CY 2011. Final rule with comment period.

This final rule with comment period addresses changes to the physician fee schedule and other Medicare Part B payment policies to ensure that our payment systems are updated to reflect changes in medical practice and the relative value of services. It finalizes the calendar year (CY) 2010 interim relative value units (RVUs) and issues interim RVUs for new and revised procedure codes for CY 2011. It also addresses, implements, or discusses certain provisions of both the Affordable Care Act (ACA) and the Medicare Improvements for Patients and Providers Act of 2008 (MIPPA). In addition, this final rule with comment period discusses payments under the Ambulance Fee Schedule (AFS), the Ambulatory Surgical Center (ASC) payment system, and the Clinical Laboratory Fee Schedule (CLFS), payments to end-stage renal disease (ESRD) facilities, and payments for Part B drugs. Finally, this final rule with comment period also includes a discussion regarding the Chiropractic Services Demonstration program, the Competitive Bidding Program for durable medical equipment, prosthetics, orthotics, and supplies (CBP DMEPOS), and provider and supplier enrollment issues associated with air ambulances.

Insurance exchanges under health reform: six design issues for the states.

The Patient Protection and Affordable Care Act depends on new, state-based exchanges to make health insurance readily available to certain segments of the population. One such segment is the lower-income uninsured, who can qualify for subsidized coverage only through an exchange. Other segments are unsubsidized individuals and small employers, who may choose to buy coverage inside or outside of an exchange. Although the law provides some guidance in structuring these new exchanges, it leaves many key decisions to the states. Successfully implementing exchanges will require public-private partnerships, expertise in insurance operations and marketing, and a series of strategic decisions. We review the half-dozen most important design issues.