CMS to Begin Competitive Bidding Outreach

BALTIMORE — After a delay because of “red
flags” CMS said it discovered in a program integrity review,
the agency appears closer to the announcement of Round 1 competitive bidding contract
winners — maybe.

“CMS has not communicated anything to anybody, except by saying
‘soon’ when contracts will be announced. Maybe it will be tomorrow
or maybe it will be two or three weeks,” said Cara Bachenheimer,
senior vice president of government relations for Elyria,
Ohio-based Invacare Corp.

But there are some signs of activity. On Tuesday, the CBIC
updated its website with a fact sheet on contract supplier obligations and information
on subcontracting requirements along with several
other documents. Yesterday, DME MAC National Government Services
alerted providers in Jurisdiction B that CMS would hold two
educational meetings in Ohio to discuss the bidding program.

Whenever the names are announced, Bachenheimer said, with just
over 10 weeks until Round 1 is scheduled to begin Jan. 1 in nine
MSAs, it will be a tight turnaround for providers to ramp up
— or down — for the transition.

She pointed out that those who have not been awarded contracts
but who might be able to continue working with Medicare
beneficiaries under the grandfather rules have a deadline of their
own. “Providers are required to give beneficiaries 30 days’ notice
if they are not going to continue,” she said. That requires more
than just a letter to beneficiaries because providers must
coordinate with contract holders to ensure continuity of care.

“I’m not sure they [CMS] understand the practical impact of some
of the decisions they make,” added Miriam Lieber of Lieber
Consulting in Sherman Oaks, Calif. “Providers need to get ready
and, quite practically, the farther out you go, the more difficult
it is to be ready.

“Providers are frustrated. They can’t move forward,” Lieber
said.

The NGS notice said the educational meetings for
providers/suppliers would be held on Oct. 27 in Cincinnati and on
Nov. 3 in Beachwood, Ohio. “If you or somebody else in your office
works with DME, please attend one of these important meetings that
will answer your questions on the DMEPOS Competitive Bidding
Program,” the listserv message
said.      

“I would hope that the [contract suppliers] would be revealed by
the time they do these education sessions,” remarked Bachenheimer.
“CMS is going to be really pressed to sufficiently educate in these
nine areas.”

Along with others in the industry, Lieber questions why CMS is
holding back on revealing the names of the bid winners.

“We are running businesses where patients are on the line for
this stuff. To compromise the integrity of businesses with patients
who are sometimes in the last days … We need to get to the
bottom of it and figure out what needs to be done,” she said,
adding, “It smells of something totally opportunistic on their
part, and they really need to ‘fess up. There is no way they
shouldn’t be prepared for something they have had all this time to
do.”

Stakeholders have wondered if CMS has run into difficulties
getting enough providers to accept contracts (the agency has said
that’s not the case) or if officials are somehow reacting
internally to the growing calls for a delay and redesign of the
program.

In September, 166 economists sent comments to Congress in which
they charged that the bidding
program’s design was fatally flawed, arguing that bids were not
binding, the pricing rule was flawed, the use of composite bids
promoted bid skewing and there was a lack of transparency.

CMS had reportedly been scheduled to meet with University of
Maryland economics professor Peter Cramton, who initiated the
letter, and White House economic advisors on Monday, but called the
meeting off. There was no word when — or if — it would
be rescheduled.

In addition, a lawsuit against the agency seeks revelation of
the financial standards to which CMS is holding bidders, and H.R.
3790, which would repeal the program, has 257 cosponsors in the
House of Representatives.

Still, CMS does not appear to be backing down from implementing
competitive bidding — even though it could.

“There is nothing magical about Jan. 1,” Bachenheimer said. “It
is not in statute. That is CMS’ deadline.”

According to the Medicare Improvement for Patients and Providers
Act, which in 2008 delayed the initial Round 1 of the bid program,
CMS was only required to begin implementation of the Round 1 rebid
in 2009, Bachenheimer said. Since that was when it opened bidding,
“they are already meeting their statutory deadline,” she
explained.

Bachenheimer said she believes CMS does have the ability to
delay the program’s implementation.

“My interpretation is that they could delay it, but they are
never going to. They are pretty committed to Jan. 1, regardless of
when they announce the contractors.”

Check out the updates on the CBIC website in the “What’s New” section.

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