Hopeful about the PAOC? Not Exactly, Says Pride’s Johnson

BALTIMORE — CMS has finalized the agenda for the first
meeting of its new Program Advisory and Oversight Committee,
established to advise the agency on competitive bidding.

Set to convene Thursday, the PAOC will look at the online
bidding system for the program, which was plagued with problems in
Round One, along with financial documentation, another area
providers say caused numerous unwarranted disqualifications in last
year’s bid. Discussion will also include legislative
requirements under the Medicare Improvements for Patients and
Providers Act, licensure, accreditation and subcontracting
requirements, new supplier issues and mail order for diabetic
testing supplies.

A tentative timeline for the bidding program, released Friday by
CMS, also will be outlined.

It’s a full agenda, but the one-day meeting still
doesn’t include “some of the things it should,”
according to Seth Johnson, vice president of government affairs for
Exeter, Pa.-based Pride Mobility Products and a member of the first
PAOC. Last October, CMS unexpectedly ended the term of the previous
PAOC and formed a new 17-member panel chaired by John Blum of CMS
and Tom Jeffers of Hill Rom. (See “Call
for New PAOC Puzzles Current Members,” Oct. 13,
2008).

“One of the things that is absent is any opportunity for
the PAOC members to talk about their experiences going through the
program last year,” said Johnson. “They are the
industry experts identified by Medicare, and they are the ones who
can talk about the changes that need to take place to improve the
program prior to any restart later this year.”

While there is a 45-minute public comment period built in at the
end of the meeting day, that’s not enough time to detail the
program’s “significant flaws” and talk about how
to correct them, Johnson said.

He pointed out “they only gave a half-hour to the online
bidding system, when there were a number of issues with that system
last year.” That issue alone needs to be a substantial
discussion, he said. “I would like to hear an overview from
CMS as to exactly what improvements they have made to address the
problems, and I don’t see how they can do that in half an
hour.”

Johnson said he would also like to hear from CMS “what
their plans are to Beta test the system so we don’t see the
same types of errors come up again” during the bidding
window.

“Another controversial issue and a very important subject
that needs a lot of discussion is financial documentation,”
Johnson continued. “One of the most surprising changes is
that they have reduced the amount of financial information
providers are required to provide from three years down to one
year. Maybe CMS’ perspective is that due to the many
disqualifications from last year that limiting the documentation
will fix that problem, but there are a lot of concerns about
requiring less information rather than more.

“When you look at some of the winners last year,” he
noted, “especially in some of the MSAs where you saw the most
provider reduction, there are lots of questions about bidders being
qualified to provide the products and services that did win and a
lot of qualified providers that did not win. I would think they
would strengthen these requirements for bidders, not relax or
weaken them.”

After potential irregularities turned up among power wheelchair
bid winners in the Riverside, Calif., bidding area, for example,
Pride called for an investigation into the matter. Johnson said
last September, his company got an acknowledgement from CMS that it
had received the information but has heard nothing since. Four
California congressmen who called for an investigation also have
not received a response, “which is very disappointing,”
Johnson said. (For more, see
“Pride Calls for Investigation in Riverside CBA,”
May 5, 2008.)

“Before any restart of the program, there needs to be a
full and independent analysis conducted of all of the issues that
were identified and any problems with bidding from last year, and
those issues need to be resolved in an appropriate manner,”
he said.

One good thing, Johnson said, is that providers and others who
don’t get to attend this week’s PAOC meeting in person
have a 30-day period in which to submit written comments about the
presentations provided by Medicare and its competitive bidding
contractor (Palmetto GBA) during the meeting.

In it previous incarnation, critics of CMS’ Round One
implementation said the PAOC was misnamed: While its name indicates
the committee members had oversight powers, they did not, and while
they were to function as well in an advisory capacity, CMS seldom
took their advice.

Whether CMS will take the PAOC’s advice this time around
is questionable, Johnson said. “I lost a lot of hope on April
17, when even absent leadership at HHS and CMS, Medicare allowed
the Interim Final Rule to go into effect, essentially finalizing
the structure and framework that we had in the program last year
… I don’t have a whole lot of hope that this new PAOC
will be any different than the previous PAOC.

“I hope I’m wrong,” Johnson continued,
“but this administration seems every bit as wedded to
competitive bidding as the previous administration. They were
unwilling to rescind the IFR or delay its implementation.

“All the way up to the very top, this administration
believes competitive bidding is a program that needs to advance.
They do not appear willing to eliminate the program or even to talk
about refining the program to make it better.”

For more on the PAOC and a list of current members, see
www.cms.hhs.gov/DMEPOSCompetitiveBid/09_Program_Advisory_and_Oversight_Committee_PAOC.asp.

For more on Thursday’s meeting, see
www.cms.hhs.gov/DMEPOSCompetitiveBid/downloads/Info_for_Registration_dmepos_060409.pdf.

The meeting schedule follows:

PROGRAM ADVISORY AND OVERSIGHT COMMITTEE (PAOC) MEETING AGENDA,
THURSDAY, JUNE 04, 2009, MARRIOTT HOTEL BWI
8:00 – 8:30 a.m. Public Registration
8:30 – 8:45 a.m. Opening Remarks
8:45 – 9:00 a.m. Introduction of New PAOC Committee
9:00 – 10:00 a.m. Background on the Program
• Standard Payment Rules
• Competitive Bidding Demonstrations
• Medicare Modernization Act of 2003
• 2008 Legislative Refinements
10:00 – 10:30 a.m. On-Line Bidding System
10:30 – 10:45 a.m. Mid-Morning Break
10:45 – 11:30 a.m. Education on Program Requirements and
Bidder Responsibilities
11:30 – 12:00 p.m. Financial Documentation
12:00 – 1:30 p.m. LUNCH (On your own)
1:30 – 2:30 p.m. Licensure, Accreditation, and Subcontracting
Requirements
2:30 – 3:15 p.m. New Supplier Issues
3:15 – 3:30 p.m. Mid-Afternoon Break
3:30 – 4:00 p.m. Mail Order – Diabetic Testing Supplies
4:00 – 4:15 p.m. Tentative Timeline
4:15 – 5:00 p.m. Public Comments