Alan Parver, a health care attorney with Powell Goldstein LLP in Atlanta, also pointed out that "enteral nutrition is the one area subject to competitive bidding where the majority of patients reside in nursing homes, not in homes."

That translates into a mix of standards, he said, because nursing homes and home care suppliers must adhere to different criteria, and the needs of the patients are different.

"When they are put into the same mix, there could be some serious issues that arise as this goes forward. There might be situations where nursing home suppliers will find themselves doing home care and home care suppliers may end up treating nursing home patients," he said. "It's a different model, a different business ... It may force nursing homes to lose suppliers they have had a long-term relationship with, that they have been comfortable with."

Parver, like other stakeholders, questioned the wisdom of including enteral nutrition in competitive bidding.