Call for New PAOC Puzzles Current Members

BALTIMORE–The Centers for Medicare and Medicaid Services’ move
to scrap its current Program Advisory and Oversight Committee, set
up to advise the agency on competitive bidding, raises a
slew of unanswered questions, some current members said last
week.

On Oct. 1, CMS issued a call for nominees for a new PAOC, one
day after sending current members a letter via FedEx notifying them
of the change, according to Seth Johnson, vice president for
government affairs for Pride Mobility Products in Exeter, Pa., and
a current PAOC member. (See HomeCare Monday Special Alert, Oct.
1.)

Johnson said it was unclear why CMS would make such a change,
particularly when a new administration, a new secretary of the
Department of Health and Human Services and a new CMS administrator
are on the horizon.

“The Medicare Improvements for Patients and Providers Act
had language in it that extended the term of the PAOC two
years,” Johnson said, referring to the legislation passed in
July that delayed the competitive bidding project for 18 months.
“But there was nothing in MIPPA that required or suggested
that they terminate the PAOC and appoint new members.”

“Nobody knows why they did it. It’s a mystery,” said
Cara Bachenheimer, senior vice president of government relations
for Elyria, Ohio-based Invacare, who has been a member since the
committee’s inception in 2004. She speculated that CMS might have
made the move “so they can show they are actually doing
something on the bidding program.”

As well, she said, “They seemed to imply they were going
to give [us] a break.”

A provision in MIPPA extends the PAOC term from 2009 to Dec. 31,
2011, she said.

Whatever the rationale, she said, “I think it’s a shame
because the PAOC members spent a lot of time being up to speed on
the most minute of details, and [CMS is] just throwing it away. I
just don’t understand what they want to accomplish.”

The PAOC was initially established in 2004 under the Medicare
Modernization Act of 2003 to advise CMS on the design and
implementation of the DMEPOS competitive bidding program. That
board included home medical equipment providers, consultants,
health care attorneys, manufacturers, supplier organizations and
others.

Both Bachenheimer and Johnson pointed out that the CMS
solicitation notice said the new PAOC would have 10 or 12 members,
down from the current 21.

“They are reducing the size of the committee,”
Johnson said, noting that just how those 10 or 12 spots will be
allocated among beneficiaries, physicians, HME suppliers,
professional standards organizations, financial standards
specialists and association representatives is another unanswered
question.

While Bachenheimer said she would likely apply for the new PAOC,
Johnson said he would not. “It’s my understanding they are
looking for new individuals,” he said.

He added that he hoped the new PAOC would include
representatives from the HME community who participated in round
one of competitive bidding.

“I really hope that [CMS] receives a significant amount of
nominations, especially from the provider community that
participated in round one of competitive bidding, and especially
those who were disqualified,” Johnson said. “Also from
providers who went through the process and ultimately were not
selected to participate in the program. They are the best ones to
speak to what needs to happen to improve the overall process and
the framework if it is to go forward.”

But the committee’s makeup, he speculated, will likely depend
“on what CMS feels it needs as far as advice to move forward
with a modified form of competitive bidding.”

Whether the new PAOC will pack any punch is also up in the air.
The current PAOC board members have been vocal in their criticism
of CMS, saying that while the committee’s name indicates they have
oversight powers, they do not, and while they were to function as
well in an advisory capacity, CMS seldom took their advice.

“I would certainly hope they would pay more attention to
the PAOC,” Johnson said, adding that would be up to the new
officials running the program.

Nominations for new PAOC members are due to CMS Nov. 3. For
information, see the CMS Web site at www.cms.hhs.gov/center/dme.asp.