CMS on NCB Rule: ‘Just Be Patient a Little Longer’

BALTIMORE–In an Open Door Forum on Wednesday, CMS officials
said once again that the final rule on DMEPOS national competitive
bidding is on the way. But when it is issued, providers still will
not get all the information they’ve been waiting on for months.

The agency has previously said that its final rule would contain
the methodology for selecting the 10 metropolitan statistical areas
where bidding will roll out, but that the names of the cities and
the products selected for the bid would follow. The timing of that
next communication and the form it might take has not been decided,
according to Joel Kaiser of CMS’ Center for Medicare
Management.

“We have to wait for the final regulation to see what our final
decision is on that … We haven’t determined exactly how we’re
going to be issuing the information on the areas and the product
categories and the items under bidding, so just be patient a little
longer and it will come,” Kaiser said.

When an audience member at the Open Door session pointed out
that “the lack of knowledge” about the cities is an issue, Kaiser
reiterated, “Unfortunately, again, we have to wait for the
rule.”

Mandated by the Medicare Modernization Act to phase in NCB in
2007, it seems CMS may also be feeling the time pressure.

On Tuesday, the agency sent the rule to the Office of Management
and Budget for a final regulatory review, estimating savings from
the bidding program at $110 million the first year and more than
$1.2 billion by the fourth year.

But CMS added this note for the OMB: “If this regulation is not
published timely, we will be unable to meet the statutory
implementation schedule and receive the anticipated savings.”

According to the American Association for Homecare, once the
rule is through OMB, it goes to the Government Printing Office to
be published in the Federal Register. “Due to the short
time frame CMS has to begin implementation of competitive bidding
before the end of 2007,” the association said, it expects that the
rule “will be cleared by OMB quickly.”

Even so, “CMS is really backing themselves into a corner now
that they haven’t released that final rule if they are going to be
able to implement competitive bidding in 2007,” said Seth Johnson,
vice president of government affairs for Pride Mobility and a
member of the Program Advisory and Oversight Committee, an industry
panel formed to advise CMS on NCB.

According to Johnson, the PAOC was told by CMS that once the
final rule is out, then the agency will follow with its Request for
Bids, which will provide “details of what products will be chosen
for what MSAs. But once the RFB documents are out,” Johnson said,
“we were told that it would be at minimum a 42-week process until
implementation. And that’s if everything goes smoothly and …
there are no hiccups in the process.”

Assuming the rule comes out by April 1, Johnson continued, “42
weeks from then is early January, and we are no longer in
2007.”

There are other indications that the agency is ramping up for
publication of the rule. At the Open Door, Kaiser repeated the
agency’s admonition to providers to get accredited. “It is very
important that suppliers begin that process now if they haven’t
already done so because there are a number of suppliers out there
in those large MSAs, and they will need to be accredited for
competitive bidding.”

He also reminded providers to update their supplier information
when enrolling with the National Supplier Clearinghouse, and noted
that the Palmetto CBIC Web site will be up “in the near future.”
CMS has selected Palmetto GBA as its Competitive Bidding
Implementation Contractor to process and evaluate bids, select
Medicare’s contract winners and set payment rates for bidding
areas. (See HomeCare Monday, Oct. 16, 2006.)

To meet CMS’ increasingly tight timeline on bidding
implementation, some industry observers have said they expect a
joint posting of some sort that would include the names of the
cities chosen as bid areas at the same time the final rule is
published.

Johnson noted, however, that CMS “has a lot of flexibility
within the MMA statute as to how they roll it out, so in theory,
CMS could, for example, implement bidding for some products in [one
city in late December] and not implement it in the other nine until
2008 and still technically meet the statutory requirements of the
law.

“Unfortunately, the longer they delay, the wilder and crazier it
will get,” he said.