COLUMBIA, S.C. — "We would like to extend our congratulations to you on winning the contracts for the Round 1 rebid. And we most importantly want to welcome you as a vital part of the success of this competitive bidding program, and we do look forward to working with you over the next few years," Cindy Dreher told listeners on a call for bid winners held Nov. 10.
According to Dreher, the CBIC's manager of policy and content, "There's already been a flurry of activity to ensure that everyone affected by this program is ready, and most importantly that beneficiaries experience a smooth transition and uninterrupted access. And the activities continue to intensify as we get closer to Jan. 1."
She wasn't kidding. After CMS' announcement of bid winners only a week ago (Nov. 3), Dreher reminded her audience that a trio of deadlines is coming up next week:
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By Nov. 17, non-contract suppliers must notify CMS — and their Medicare patients — of whether or not they will become grandfathered suppliers.
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By Nov. 18, contract suppliers must disclose subcontracting arrangements.
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Nov. 19 is the cut-off date for bid losers to make inquiries to the CBIC about why they lost out.
That timeline was a little too intense for one provider from the Kansas City CBA who called in to ask for an explanation.
"We are a contracted bid winner for the Kansas City area, but there are also some categories that we are not contracted on," said Steve Stanholtzer of Unimed. "I am just curious what the explanation is or how CMS could possibly say that is it reasonable to expect us as suppliers to notify all of our beneficiaries regarding grandfathering in less than two weeks, when the original intent was to give us two-and-a-half months to do so. It just seems unreasonable to make that expectation when CMS was two-and-a-half months late in making the announcement of contracted winners."
Replied Dreher, "We appreciate your comment and I think we've addressed that earlier."
Nope, said Stanholtzer. "You haven't addressed how it's reasonable that we can do that in two weeks when we were originally supposed to be given two-and-a-half months."
But Dreher noted there were "sample forms available to help you" and said that regulations require the notification date to be 30 business days prior to the implementation of the contracts.
Walt Gorski of the American Association for Homecare also told Dreher the association was hearing about the beneficiary notification date both from contract and non-contract suppliers.
"As we've expressed, there is some serious concern among the supplier community that there are an awful lot of patients to notify. I'm curious," Gorski said. "What is CMS' penalty if the 17th deadline of notifying patients is missed?" He also asked for an explanation of what "proof of delivery" means according to CMS, and how either CMS or the CBIC would be tracking the information regarding the letters sent to beneficiaries.
"Suppliers do not have to send a certified letter to their patients, which of course would be the absolute proof of delivery, but that is not a requirement. It's much like when you send the purchase option letter for the rental of equipment," responded Dreher. "You would just need to take the letter, make a copy of it, put it in the file and document when the letter was mailed," she said. About tracking, she said, "We aren't going to be visiting every supplier to find out if the letter is in there, but in case we would ever ask for it, it would need to be made available."
While Dreher did not point to a specific penalty for missing the deadline, she said the final rule requires that the letters "be put out there 30 business days prior to the implementation of the program, so of course we would expect that suppliers who choose to grandfather or not grandfather inform the beneficiaries by that date."
Gorski also noted that the statute calls for an Office of Inspector General review of the calculations under competitive bidding, but CMS' Michael Keane said there was no further information on the OIG study.
During her presentation, Dreher ticked through a list of CMS/CBIC education and outreach activities, the CBIC ombudsman program, marketing guidelines (contract suppliers can say they are a "Medicare contract supplier," she said) and contract supplier obligations, including this reminder:
"The regulations require that a contract supplier comply with all terms of the contract for the full duration of the contract period. This means that contract suppliers must be ready to furnish all items in the product categories in the CBAs for which they are awarded a contract and meet all program requirements on Day 1, which is Jan. 1, 2011, of the contract period and then continue to meet all program requirements until the contract period ends."
The three-year contract term is up on Dec. 31, 2013, for all product categories except diabetic supplies; that contract ends Dec. 31, 2012.
That category is one Andrew D'Onofrioof Diabetes Providers in Jupiter, Fla., called in about. The cost for some of the brand name products that many of his 222 diabetic patients use is higher than the allowed amount, he commented. "I have checked with some of the suppliers and they can't supply my patients with items they are currently on …
"The problem we ran into in the first bid was that patients could not receive the supplies they were accustomed to," said D'Onofrio, specifically pointing to Bayer, Roche, FreeStyle (Abbott) and LifeScan. "There is no provider that I have spoken with who can purchase those goods at a price that will allow them to stay in business," he said, "so how will you verify that my patients will not be switched to a lower-priced imported item?"
"We will be closely monitoring what items are provided to Medicare beneficiaries," Dreher said, through claims analysis, following up with ombudsmen and "using all the usual channels." Contract suppliers will also be required to report "what items by brand names and the approximate number that were furnished to beneficiaries during the previous quarter," she said, adding that under the bidding rules, Medicare beneficiaries must get the same products that are provided to other patients.
What about now, asked D'Onofrio? "I'm trying to find placement for my more than 200 patients for products. Seventy percent of the products we sell are Bayer products, and they all cost more than the allowed amount … so when my patients have to go elsewhere they are going to be calling me to help them find a new provider," he said. "I'd like to know which providers are providing those four particular brands so I can send my patients there."
Dreher said the supplier directory at www.Medicare.gov would have brand information for the top codes in each bid category so beneficiaries can call 1-800-Medicare for that information.
Added Keane, "We did award contracts to suppliers that said that they are going to provide these mentioned manufacturer names, and in late December, we will be posting all the manufacturer brands on the locator tool so folks can go on there and look and find a contract supplier in their area and locate those particular items and manufacturers."
Dreher said a replay and transcript of Wednesday's call would be posted on the CBIC website.
The CBIC has scheduled another call for contract suppliers on Wednesday, Nov. 17, with registration information to come.
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