AAHomecare Lists Problems with Competitive Bidding NPRM

WASHNGTON–AAHomecare recently outlined its top concerns with
CMS’ competitive bidding Notice of Proposed Rulemaking, published
May 1 (see HomeCare
Monday, May 1). According to the association:

• Getting it right is more important than rushing implementation.
  CMS should stagger the bidding in MSAs in 2007 to allow for an
  orderly roll-out. This would allow CMS to identify problems that
  occur and correct them before they become widespread. Also, the
  initial MSAs and products selected should be identified in the
  final rule. And under the timeline CMS is proposing, small
  providers will not have time to create networks, which eliminates
  them as a practical option for small providers that want to
  participate.

• Have accreditation and standards in place before starting. Only
  accredited providers should be eligible to submit bids. CMS should
  not proceed with competitive bidding until this is possible and
  needs to identify the criteria it will use to identify the
  accrediting bodies now. CMS should grandfather all providers
  accredited by organizations that meet the criteria it identifies,
  and should allow additional time for providers to analyze the
  quality standards in conjunction with the proposed competitive
  bidding rule. The quality standards will affect the cost of
  servicing beneficiaries and are an integral part of the bid
  process.

• Make competitive bidding competitive and sustainable. CMS should
  not artificially limit bids by disqualifying bids above the current
  fee schedule amount for an item. Otherwise, the competition is not
  truly competitive based on market prices. Bid evaluation and the
  selection of winning bidders should be designed to result in
  pricing that is rational and sustainable. CMS has not identified
  any process through which it will seek to determine that the bids
  are either.

• Don’t make it harder for providers to sell their businesses. The
  proposal to restrict the acquisition of a winning provider unless
  CMS needs to replace the supplier’s capacity within the bidding
  area places an inappropriate restriction on the provider’s property
  rights. While it is appropriate for CMS to consider the buyer’s
  quality and financial stability, CMS should not make approval of
  the acquisition contingent on the need to preserve capacity within
  the MSA.

• Consider the impact on the patient. CMS cannot rely solely on
  costs and volume for product selection. Consider issues such as
  access and medical necessity of beneficiaries who use the items.
  Competitive bidding should not be a substitute for appropriate
  medical policy.

Additional concerns include the NPRM’s composite score
methodology, the rebate program, product selection, the bid
process, how CMS will determine the number of suppliers needed to
meet demand in bidding areas, what measures will be used to figure
out the savings that would result from bidding on an item,
gap-filling and networks.

To view CMS’ Notice of Proposed Rulemaking on competitive
bidding,
click here.

For a summary of the proposed competitive bidding rule,
click here.

CMS is accepting comments on the proposal through June 30. To
comment, visit www.cms.hhs.gov/eRulemaking.