PAOC Is Big Forum

The Centers for Medicare and Medicaid Services held its first meeting of the Program Advisory and Oversight Committee (PAOC) on Oct. 6 to provide advice as CMS implements the competitive bidding provisions mandated by last year’s Medicare Prescription Drug, Improvement and Modernization Act (MMA). As a member of that panel, I believe we have an enormous responsibility to provide CMS with constructive inputs to this process.

This is not the forum to register our collective and fierce opposition to competitive bidding. Rather, Congress is the appropriate audience for that message since it was Congress that wrote the law. Until Congress repeals or changes the competitive bidding provisions, CMS has no choice but to move forward and work on its implementation plan.

While it is too early to assess whether CMS will incorporate the counsel of the PAOC into its implementation plans — and panel members expressed differing views on multiple issues, making that task far more difficult — the process provides a forum not just for PAOC members but also for the larger industry to give input.

During the meeting, the panel heard presentations from CMS and its contractor, Research Triangle Institute (RTI), about various issues related to the two competitive bidding demonstrations and implementation of the competitive bidding program that will begin in 2007. RTI presented a summary of its evaluation report of the Polk County, Fla., and San Antonio, Texas, demonstrations that were conducted between 1999 and 2002.

RTI also presented the committee with a series of questions related to structuring the competitive bidding program. For example, should CMS use one or more of the DMERCs or another entity to administer the various functions — such as bid evaluation, quality and access monitoring, and evaluation — of a competitive bidding program?

CMS plans to gain input from the PAOC on the development of quality standards, also mandated in last year’s MMA. The panel heard a presentation from RTI, whose representatives had already met with a number of the major accreditation organizations. On these issues, CMS was receptive to input regarding these questions:

Should CMS develop its own standards or work collaboratively with existing accreditation organizations? Should CMS require suppliers to comply with the quality standards at the time the competitive bidding provisions are implemented? What other organizations should CMS and its contractor contact? (One, for example, might be NRRTS, the National Registry of Rehabilitation Technology Suppliers, which has certification programs for individuals.) How should the quality standards be enforced and monitored?

CMS also announced the following tentative timetable to implement competitive bidding:

• Spring 2005 — CMS will publish in the Federal Register a Notice of Proposed Rulemaking, to include certain MMA provisions such as: criteria for selection of geographic areas, phased-in implementation in 10 of the largest metropolitan statistical areas (MSAs) in 2007 and 80 of the largest MSAs in 2009, and additional areas after 2009; criteria for initial and subsequent DMEPOS items to include in the competitive bidding program; criteria for the bid evaluation process; and structure for implementation.
• Summer 2005 — Public comment period
• Fall 2005 — CMS completes review of comments and discusses outstanding issues with PAOC
• Spring 2006 — CMS will publish in the Federal Register the Final Regulation for National Competitive Bidding
• Spring 2006 to end of 2006 — Beneficiary and supplier education; systems changes; request and evaluate supplier bids; award supplier contracts; and review outstanding issues with the PAOC
• January 2007 — Initiate competitive bidding in 10 of the largest MSAs (Contracts must be recompeted every three years.)

CMS has posted materials and the presentations discussed at the October 6 meeting on its competitive bidding Web site at www.cms.hhs.gov/suppliers/dmepos/compbid/.

A specialist in health care legislation, regulations and government relations, Cara C. Bachenheimer is vice president, government relations, for Invacare Corp., Elyria, Ohio. Bachenheimer previously worked at the law firm of Epstein, Becker & Green in Washington, D.C., and at the American Association for Homecare and the Health Industry Distributors Association. You can reach her by phone at 440/329-6226 or by e-mail at [email protected].